Provider Demographics
NPI:1578641742
Name:REEVES, AMY OWEN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:OWEN
Last Name:REEVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5455 MERIDIAN MARK RD #130
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-255-2033
Mailing Address - Fax:404-252-1901
Practice Address - Street 1:5150 STILESBORO RD NW STE 220
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7742
Practice Address - Country:US
Practice Address - Phone:770-424-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004838363AM0700X, 363A00000X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology