Provider Demographics
NPI:1669479945
Name:REESE, I PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:I
Middle Name:PHILIP
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 1:182 PERRY HOUSE RD
Mailing Address - Street 2:SUITE C&D
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8721
Mailing Address - Country:US
Mailing Address - Phone:229-424-7273
Mailing Address - Fax:229-424-7280
Practice Address - Street 1:182 PERRY HOUSE RD
Practice Address - Street 2:SUITE C&D
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8721
Practice Address - Country:US
Practice Address - Phone:229-424-7273
Practice Address - Fax:229-424-7280
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8640207RC0000X
GA066407207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8C0437OtherMEDICARE ID-TYPE UNSPECIFIED
GAE29337Medicare UPIN