Provider Demographics
NPI:1912787854
Name:REESER, MARISA (PA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:REESER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 RIVER HEIGHTS CT SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4893
Mailing Address - Country:US
Mailing Address - Phone:203-206-5601
Mailing Address - Fax:
Practice Address - Street 1:960 JOHNSON FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1601
Practice Address - Country:US
Practice Address - Phone:404-943-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant