Provider Demographics
NPI:1922194018
Name:REEVES, MICHELLE LEA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LEA
Last Name:REEVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 PAULSEN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4423
Mailing Address - Country:US
Mailing Address - Phone:912-354-7546
Mailing Address - Fax:
Practice Address - Street 1:4849 PAULSEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4423
Practice Address - Country:US
Practice Address - Phone:912-354-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004233363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCGKBMedicare ID - Type Unspecified