Provider Demographics
NPI:1053532838
Name:REECE, IRENE BRIGETTA (LMT, ND)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:BRIGETTA
Last Name:REECE
Suffix:
Gender:F
Credentials:LMT, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SPRINGFIELD CENTER DRIVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188
Mailing Address - Country:US
Mailing Address - Phone:404-514-3129
Mailing Address - Fax:
Practice Address - Street 1:104 SPRINGFIELD CENTER DRIVE
Practice Address - Street 2:SUITE 117
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:404-514-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist