Provider Demographics
NPI:1356580641
Name:MICHAEL D. REESE, M.D., P.C.
Entity type:Organization
Organization Name:MICHAEL D. REESE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-944-8485
Mailing Address - Street 1:9280 HIGHWAY 5
Mailing Address - Street 2:SUITE D
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1501
Mailing Address - Country:US
Mailing Address - Phone:770-944-8485
Mailing Address - Fax:770-944-8550
Practice Address - Street 1:9280 HIGHWAY 5
Practice Address - Street 2:SUITE D
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1501
Practice Address - Country:US
Practice Address - Phone:770-944-8485
Practice Address - Fax:770-944-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01BDHLQOtherMEDICARE
GA843752OtherBCBS OF GA
GA2032867OtherAETNA HMO
GA310584454OtherCHAMPUS/TRICARE
GA4261769OtherAETNA PPO
GA0100389OtherUNITED HEALTHCARE HMO
GA000173148CMedicaid
GA843752OtherGA FIRST
GA010064309OtherRAILROAD MEDICARE
GA843752OtherBLUE CHOICE PPO
GA4261769OtherAETNA PPO