Active NPI
Howard Alan Reisman, M.D.
- Gynecology Physician
- Roswell, GA
National Provider Identifier
1407833205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 021428
- Practice address
- 11050 Crabapple Rd
Suite 111D
Roswell, GA 30075-2489 - Phone
- (770) 992-2691
- Fax
- (770) 518-8042
- NPI assigned
- Dec 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 021428 | GA | Primary |
Addresses
Primary practice location
11050 Crabapple Rd
Suite 111D
Roswell, GA 30075-2489
Mailing address
11050 Crabapple Rd
Suite 111D
Roswell, GA 30075-2489
Phone (770) 992-2691
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021428 | GA | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291075200000",
"number": "1407833205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11050 CRABAPPLE RD",
"address_2": "SUITE 111D",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300752489",
"telephone_number": "770-992-2691",
"fax_number": "770-518-8042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11050 CRABAPPLE RD",
"address_2": "SUITE 111D",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300752489",
"telephone_number": "770-992-2691",
"fax_number": "770-518-8042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REISMAN",
"first_name": "HOWARD",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2010-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "GA",
"license": "021428",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.