Individual
WAYNE RANSOM REAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2092 PRINCE AVE, ATHENS, GA 30606-6047
(706) 549-2410
Mailing address
P.O. BOX 48174, ATHENS, GA 30604
(706) 549-2410
(706) 369-8968
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52070313
BLUE CROSS BLUE SHIELD GA
GA
Enumeration date
07/10/2006
Last updated
12/06/2007
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