Provider Demographics
NPI:1053352625
Name:REISMAN, ARTHUR GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:GERALD
Last Name:REISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARTHUR
Other - Middle Name:GERALD
Other - Last Name:REISMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1428 DUNWOODY VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-394-2358
Mailing Address - Fax:770-394-3055
Practice Address - Street 1:1428 DUNWOODY VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-394-2358
Practice Address - Fax:770-394-3055
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030421208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000377066Medicaid
GA000377066Medicaid