Provider Demographics
NPI:1720895915
Name:REESE, NICHOLAS H (MA)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:H
Last Name:REESE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W COLLEGE ST STE C
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4250
Mailing Address - Country:US
Mailing Address - Phone:470-743-8264
Mailing Address - Fax:
Practice Address - Street 1:220 W COLLEGE ST STE C
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4250
Practice Address - Country:US
Practice Address - Phone:470-743-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist