Provider Demographics
NPI:1598555716
Name:REECE, LUANA
Entity type:Individual
Prefix:
First Name:LUANA
Middle Name:
Last Name:REECE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 MAPLE ST SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1649
Mailing Address - Country:US
Mailing Address - Phone:808-342-0029
Mailing Address - Fax:
Practice Address - Street 1:1189 MAPLE ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1649
Practice Address - Country:US
Practice Address - Phone:808-342-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054960572172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver