Provider Demographics
NPI:1598832792
Name:REYNOLDS, KAREN (MD)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-0366
Mailing Address - Country:US
Mailing Address - Phone:843-335-8291
Mailing Address - Fax:843-335-8731
Practice Address - Street 1:645 S. 7TH ST
Practice Address - Street 2:
Practice Address - City:MCBEE
Practice Address - State:SC
Practice Address - Zip Code:29101
Practice Address - Country:US
Practice Address - Phone:843-335-8291
Practice Address - Fax:843-335-8731
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT56668Medicaid
SC21527OtherMEDICAL LICENSE NUMBER
SCH09795Medicare UPIN