Provider Demographics
NPI:1922382886
Name:REEVES, SUSAN DIXON
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIXON
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3888 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1865
Mailing Address - Country:US
Mailing Address - Phone:478-471-6744
Mailing Address - Fax:478-471-9936
Practice Address - Street 1:3888 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1865
Practice Address - Country:US
Practice Address - Phone:478-471-6744
Practice Address - Fax:478-471-9936
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist