Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1043694631 |
---|---|
Provider Name | Dr. Justin Reese |
First Address | Newnan, GA 30263-5768 |
Second Address | Newnan, GA 30263-5768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2015 |
Last Update Date | 14/07/2015 |