Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 053393 | GA |
N | 207ND0900X | Dermatopathologist | 053393 | GA |
N | 207NS0135X | Procedural Dermatology | 053393 | GA |
NPI | 1417949777 |
---|---|
Provider Name | Matthew J Reschly |
First Address | Duluth, GA 30096-4807 |
Second Address | Duluth, GA 30096-4807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 02/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
703213 | BCBS (01) | GA |
749377509A | (05) | GA |
749377509C | (05) | GA |
749377509D | (05) | GA |
749377509E | (05) | GA |
H93464 | (02) | |
P00119685 | RR MEDICARE (01) | GA |