Organization
EDENTON UROLOGY CLINIC
Active
Organization
EDENTON UROLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL CRIST REYNOLDS MD (PRESIDENT)
(252) 482-1606
Entity
Organization
Contact information
Practice address
210 N BROAD ST, EDENTON, NC 27932
(252) 482-1606
(252) 482-1611
Mailing address
210 N BROAD ST, EDENTON, NC 27932-1904
(252) 482-1606
(252) 482-1611
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
9900331
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0289T
BCBS
—
05
—
790289T
—
NC
Enumeration date
11/29/2006
Last updated
08/22/2020
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