Provider Demographics
NPI:1013925999
Name:REAVES, VERA ANNETTE (MD)
Entity Type:Individual
Prefix:MS
First Name:VERA
Middle Name:ANNETTE
Last Name:REAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 VIRGINIA PINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047
Mailing Address - Country:US
Mailing Address - Phone:770-638-3570
Mailing Address - Fax:
Practice Address - Street 1:2892 MOUNTAIN INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3014
Practice Address - Country:US
Practice Address - Phone:678-534-0452
Practice Address - Fax:678-534-1534
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
038076OtherGEORGIA LICENSE
GA000596626FMedicaid
038076OtherGEORGIA LICENSE
GA08BBWSLMedicare ID - Type Unspecified