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NPI Code Detail

MEDICARE: MICHAEL ANTHONY REYNOLDS JR. MD

MEDICARE: MICHAEL ANTHONY REYNOLDS JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician86069SC

General Provider Information

NPI Number : 1144896317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ANTHONY REYNOLDS JR. MD
Provider Business Mailing Address
First Line : PO BOX 751461
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1461
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 171 ASHLEY AVE
Second Line :
City : CHARLESTON
State : SC
Zip : 29425-8908
Country : US
Telephone Number : 843-792-1414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2021
Last Update Date : 06/09/2026

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