Provider Demographics
NPI:1295826881
Name:REID, JAMES D III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:REID
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2555 COURT DR STE 450
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2191
Mailing Address - Country:US
Mailing Address - Phone:704-671-7652
Mailing Address - Fax:704-671-7656
Practice Address - Street 1:2555 COURT DR STE 450
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2191
Practice Address - Country:US
Practice Address - Phone:704-671-7652
Practice Address - Fax:704-671-7656
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC19995208600000X
NC2015-00415208600000X
TXT9485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG69246Medicare UPIN
SCG69246Medicare UPIN