Provider Demographics
NPI:1649089566
Name:REESE, MARY LATRELLE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LATRELLE
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MONTEGO CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3617
Mailing Address - Country:US
Mailing Address - Phone:404-548-3100
Mailing Address - Fax:
Practice Address - Street 1:1393 CLEVELAND AVE STE 107EAST
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3423
Practice Address - Country:US
Practice Address - Phone:404-548-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician