Organization
WADE D REYNOLDS DO, LLC
Active
Other names
Ivy Park Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WADE REYNOLDS DO (PRESIDENT)
(803) 785-4555
Entity
Organization
Contact information
Practice address
111 IVY PARK LN, SUITE C, LEXINGTON, SC 29072-8289
(803) 785-4555
(803) 785-4556
Mailing address
111 IVY PARK LANE, SUITE C, LEXINGTON, SC 29072-8289
(803) 785-4555
(803) 785-4556
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0417
SC
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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