Provider Demographics
NPI:1922063114
Name:REESE, BETTI D (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTI
Middle Name:D
Last Name:REESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5500 W FRIENDLY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4212
Mailing Address - Country:US
Mailing Address - Phone:336-856-9996
Mailing Address - Fax:336-856-9976
Practice Address - Street 1:5500 W FRIENDLY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4212
Practice Address - Country:US
Practice Address - Phone:336-856-9996
Practice Address - Fax:336-856-9976
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200100186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128G7Medicaid
NC2295215AMedicare PIN
NC89128G7Medicaid