Basic Information
| Provider Information | |||||||||
| NPI: | 1902863848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REECE | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 LACY ST NW | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704264721 | ||||||||
| FaxNumber: | 6787974119 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 LACY ST NW | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704264721 | ||||||||
| FaxNumber: | 6787974119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN069821 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 00961089A | 05 | GA | MEDICAID | P90594 | 01 | GA | UPIN | OTHER |