Provider Demographics
NPI:1417923707
Name:REYES, JOSE ISMAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ISMAEL
Last Name:REYES
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11125 JONES BRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-0001
Mailing Address - Country:US
Mailing Address - Phone:678-383-0008
Mailing Address - Fax:470-735-6656
Practice Address - Street 1:11125 JONES BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-0001
Practice Address - Country:US
Practice Address - Phone:678-383-0008
Practice Address - Fax:470-735-6656
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ425932084P0800X
GA1023972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ558601Medicaid
PA101847625Medicaid
AZ558601Medicaid
PA110204Medicare PIN