Provider Demographics
NPI:1518941376
Name:MCREYNOLDS, JOEL MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MATTHEW
Last Name:MCREYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22725 HIGHWAY 76 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325
Practice Address - Country:US
Practice Address - Phone:864-833-9100
Practice Address - Fax:864-833-9458
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44301207R00000X
SC36908207R00000X, 208M00000X
NV10971207R00000X, 208M00000X
IN01080560A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC369087Medicaid
NV100503565Medicaid
NV100503565Medicaid
H85010Medicare UPIN