Provider Demographics
NPI:1902863848
Name:REECE, VICKI H (NP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:H
Last Name:REECE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:140 LACY ST NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1114
Mailing Address - Country:US
Mailing Address - Phone:770-426-4721
Mailing Address - Fax:678-797-4119
Practice Address - Street 1:140 LACY ST NW
Practice Address - Street 2:SUITE B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1114
Practice Address - Country:US
Practice Address - Phone:770-426-4721
Practice Address - Fax:678-797-4119
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN069821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00961089AMedicaid
GAP90594OtherUPIN
GA50BBFVQMedicare ID - Type UnspecifiedMEDICARE