Basic Information
Provider Information
NPI: 1033556477
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REICH
FirstName: ROBERT
MiddleName: ALLEN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2758 BRECKENRIDGE CT NE
Address2:  
City: ATLANTA
State: GA
PostalCode: 303454001
CountryCode: US
TelephoneNumber: 4046336548
FaxNumber:  
Practice Location
Address1: 2758 BRECKENRIDGE CT NE
Address2:  
City: ATLANTA
State: GA
PostalCode: 303454001
CountryCode: US
TelephoneNumber: 4046336548
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/24/2013
LastUpdateDate: 05/24/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X8273GAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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