Individual
JESSICA LEIGH REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2995 REIDVILLE RD STE 210, SPARTANBURG, SC 29301-5631
(864) 253-8140
(864) 587-0051
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33622
SC
207R00000X
Internal Medicine Physician
LL33622
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
336229
—
SC
01
—
SC77205019
MEDICARE PIN
SC
Enumeration date
06/02/2011
Last updated
12/10/2020
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