Individual provider Active NPI

Timothy Drew Reese, RDN

  • Registered Dietitian
  • Madison, GA
National Provider Identifier
1154824704
Registry record updated Mar 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
LD002753 Issued in GA
Practice address
1077 S Main St
Madison, GA 30650-2073
Phone
(706) 752-2223
NPI assigned
Mar 9, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 875900
Registered Dietitian 133V00000X LD002753 GA Primary

Addresses

Primary practice location

1077 S Main St
Madison, GA 30650-2073

Mailing address

PO Box 860
Madison, GA 30650-0860
Phone (706) 752-2223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LD002753GAMDRegistered Dietitian

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520553600000",
    "number": "1154824704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306500860",
            "telephone_number": "706-752-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1077 S MAIN ST",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306502073",
            "telephone_number": "706-752-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REESE",
        "first_name": "TIMOTHY",
        "middle_name": "DREW",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-09",
        "last_updated": "2018-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "875900",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD002753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.