Provider Demographics
NPI:1063291110
Name:REESE, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2976
Mailing Address - Country:US
Mailing Address - Phone:762-436-0777
Mailing Address - Fax:
Practice Address - Street 1:2602 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2976
Practice Address - Country:US
Practice Address - Phone:762-436-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor