Provider Demographics
NPI:1255391165
Name:REECE, ELIZABETH A (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:REECE
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 1:2040 DAN PROCTOR DR STE 140
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3812
Mailing Address - Country:US
Mailing Address - Phone:912-673-8000
Mailing Address - Fax:912-673-8003
Practice Address - Street 1:2040 DAN PROCTOR DR STE 140
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3812
Practice Address - Country:US
Practice Address - Phone:912-673-8000
Practice Address - Fax:912-673-8003
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82181208000000X
NC2017-01097208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003216799AMedicaid
IN200294110Medicaid
IN172580YMedicare PIN