Provider Demographics
NPI:1659364040
Name:REESE, ROBERT VERNON (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VERNON
Last Name:REESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-0968
Mailing Address - Country:US
Mailing Address - Phone:229-423-4384
Mailing Address - Fax:229-423-4387
Practice Address - Street 1:201 W PINE ST
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-2863
Practice Address - Country:US
Practice Address - Phone:229-423-4384
Practice Address - Fax:229-423-4387
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000380828AMedicaid
GA000380828AMedicaid