Provider Demographics
NPI:1689122731
Name:REESE, TANYA (PARAPROFESSIONAL)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:PARAPROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109A HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-2879
Mailing Address - Country:US
Mailing Address - Phone:229-591-5236
Mailing Address - Fax:
Practice Address - Street 1:109A HOLLY DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-2879
Practice Address - Country:US
Practice Address - Phone:229-591-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25830171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor