Provider Demographics
NPI:1912007105
Name:REYNOLDS, JARROD (MD)
Entity Type:Individual
Prefix:DR
First Name:JARROD
Middle Name:
Last Name:REYNOLDS
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:P.O. BOX 608
Mailing Address - Street 2:
Mailing Address - City:MCCLELLANVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29458-0608
Mailing Address - Country:US
Mailing Address - Phone:843-887-3274
Mailing Address - Fax:843-887-3929
Practice Address - Street 1:1189 TIBWIN ROAD
Practice Address - Street 2:
Practice Address - City:MCCLELLANVILLE
Practice Address - State:SC
Practice Address - Zip Code:29458-9405
Practice Address - Country:US
Practice Address - Phone:843-887-3274
Practice Address - Fax:843-887-3929
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82614207R00000X
SC27091208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics