Provider Demographics
NPI:1710103619
Name:REYES, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1551
Mailing Address - Country:US
Mailing Address - Phone:404-446-2496
Mailing Address - Fax:404-446-2497
Practice Address - Street 1:6335 HOSPITAL PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1551
Practice Address - Country:US
Practice Address - Phone:404-446-2496
Practice Address - Fax:404-446-2497
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD130914207VG0400X
GA064060207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA064060OtherMEDICAL LICENSE
GA681735673AMedicaid