Provider Demographics
NPI:1659607661
Name:REESE, VENNA (HEALTH PROFESSION)
Entity Type:Individual
Prefix:MS
First Name:VENNA
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:HEALTH PROFESSION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 PRESCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4308
Mailing Address - Country:US
Mailing Address - Phone:706-284-9959
Mailing Address - Fax:706-955-8425
Practice Address - Street 1:4027 PRESCOTT DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4308
Practice Address - Country:US
Practice Address - Phone:706-284-9959
Practice Address - Fax:706-955-8425
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities