Provider Demographics
NPI:1659353886
Name:REYNOLDS, DONALD JAMES JR (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:REYNOLDS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:1210 W FARIS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4444
Practice Address - Country:US
Practice Address - Phone:864-522-1800
Practice Address - Fax:864-522-1806
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC817002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4187363OtherTNCARE SELECT
AL009932442Medicaid
AL009932443Medicaid
TN4187363OtherBCBS
AL009932444Medicaid
AL51001619OtherBC GREYSTONE
AL51001628OtherBC 280
AL51001630OtherBC SYLACAUGA
SC817004Medicaid
AL51001624OtherBC MONTCLAIR
AL009932446Medicaid
AL009934022Medicaid
TN3300039Medicaid
AL51001627OtherBC SHELBY
P00632720OtherRAILROAD MEDICARE
P00632720OtherRAILROAD MEDICARE
GA47BBBFQMedicare ID - Type UnspecifiedCOLUMBUS DIAGNOSTIC CENTE