Individual provider Active NPI

Mary Latrelle Reese

  • Clinical Laboratory Director (Non-physician)
  • East Point, GA
National Provider Identifier
1649089566
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Laboratory Director (Non-physician)Taxonomy code 247ZC0005X
Practice address
1393 Cleveland Ave Ste 107East
East Point, GA 30344-3423
Phone
(404) 548-3100
NPI assigned
Jan 6, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Laboratory Director (Non-physician) 247ZC0005X Primary

Addresses

Primary practice location

1393 Cleveland Ave Ste 107East
East Point, GA 30344-3423

Mailing address

290 Montego Cir
Riverdale, GA 30274-3617
Phone (404) 548-3100

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

NPI Registry JSON

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

{
    "created_epoch": "1736121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1649089566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 MONTEGO CIR",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302743617",
            "telephone_number": "404-548-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1393 CLEVELAND AVE STE 107EAST",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443423",
            "telephone_number": "404-548-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REESE",
        "first_name": "MARY",
        "middle_name": "LATRELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-06",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247ZC0005X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Point, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.