Provider Demographics
NPI:1669651329
Name:DRS. REEVES & SMITH, PC
Entity Type:Organization
Organization Name:DRS. REEVES & SMITH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-863-5635
Mailing Address - Street 1:3614 J DEWEY GRAY CIR STE A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6512
Mailing Address - Country:US
Mailing Address - Phone:706-863-5635
Mailing Address - Fax:
Practice Address - Street 1:3614 J DEWEY GRAY CIR STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6512
Practice Address - Country:US
Practice Address - Phone:706-863-5635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012129174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD91012Medicare UPIN
GAD30585Medicare UPIN