Provider Demographics
NPI:1770629040
Name:REYNOLDS, MARK A (BCHIS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:BCHIS
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 1240
Mailing Address - Street 2:
Mailing Address - City:PISGAH FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:28768-1240
Mailing Address - Country:US
Mailing Address - Phone:828-884-3600
Mailing Address - Fax:
Practice Address - Street 1:102 COLLEGE STATION DR
Practice Address - Street 2:STE 9
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3194
Practice Address - Country:US
Practice Address - Phone:828-884-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC290237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist