Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | 004838 | GA |
NPI | 1578641742 |
---|---|
Provider Name | Miss Amy Owen Reeves |
First Address | Atlanta, GA 30342 |
Second Address | Kennesaw, GA 30152-7742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 06/11/2019 |