Provider Demographics
NPI:1962442095
Name:REEVES, MARY NELL (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NELL
Last Name:REEVES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3143
Mailing Address - Country:US
Mailing Address - Phone:706-882-9940
Mailing Address - Fax:706-882-9968
Practice Address - Street 1:311 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3143
Practice Address - Country:US
Practice Address - Phone:706-882-9940
Practice Address - Fax:706-882-9968
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN042680176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR13121Medicare UPIN