Provider Demographics
NPI:1023064870
Name:TORRES, REYES III (PA-C)
Entity type:Individual
Prefix:MR
First Name:REYES
Middle Name:
Last Name:TORRES
Suffix:III
Gender:M
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 1:3502 VALLEYHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6439
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-424-2024
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:770-424-2024
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA889528440FMedicaid
GA889528440EMedicaid
GA889528440BMedicaid
GA889528440BMedicaid