Provider Demographics
NPI:1770186702
Name:REYNOLDS CARDIOLOGY PLLC
Entity Type:Organization
Organization Name:REYNOLDS CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:601-420-0141
Mailing Address - Street 1:309A MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5239
Mailing Address - Country:US
Mailing Address - Phone:601-708-8390
Mailing Address - Fax:601-708-8391
Practice Address - Street 1:309A MORRISON DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5239
Practice Address - Country:US
Practice Address - Phone:601-708-8309
Practice Address - Fax:601-708-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty