Individual
JUDD M REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
50 PARKWAY LN, PETAL, MS 39465-3035
(601) 544-7404
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 544-7404
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24473
MS
224Z00000X
Occupational Therapy Assistant
TA2169
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09807844
—
MS
Enumeration date
05/07/2008
Last updated
06/30/2021
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