Provider Demographics
NPI:1003092776
Name:REISMAN, NATALIE MOORE (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:MOORE
Last Name:REISMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:JEAN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6335 HOSPITAL PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1550
Mailing Address - Country:US
Mailing Address - Phone:770-712-4616
Mailing Address - Fax:678-256-3897
Practice Address - Street 1:6335 HOSPITAL PKWY STE 111
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1550
Practice Address - Country:US
Practice Address - Phone:770-712-4616
Practice Address - Fax:678-256-3897
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-12
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60860207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology