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Individual

MARK REYNOLDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
840 WEST FLOYD BAKER BLVD, GAFFNEY, SC 29340
(864) 489-3300
Mailing address
PO BOX 277723, ATLANTA, GA 30384

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23064
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
NP6418
SC
01
SCG602H888
MEDICARE PIN
SC
01
SCG602J577
MEDICARE PIN
SC
Enumeration date
07/24/2019
Last updated
12/10/2020
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