Provider Demographics
NPI:1053391490
Name:REISMAN, ANDREW BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRADLEY
Last Name:REISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:4222 FAIRBANKS DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2811
Practice Address - Country:US
Practice Address - Phone:770-534-6053
Practice Address - Fax:770-534-6695
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA341309OtherWELLCARE
GA52595494OtherBCBS
GA10045366OtherAMERIGROUP
GA000716878AMedicaid
GA4969623OtherCIGNA
GA5218658OtherAETNA PPO
GA0100333OtherUNITED HEALTHCARE
GA80109236OtherRR MEDICARE-GRP # CC4177
GA10045366OtherAMERIGROUP
GA4969623OtherCIGNA