Healthcare Provider Details

I. General information

NPI: 1770186702
Provider Name (Legal Business Name): REYNOLDS CARDIOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309A MORRISON DR
CLINTON MS
39056-5239
US

IV. Provider business mailing address

309A MORRISON DR
CLINTON MS
39056-5239
US

V. Phone/Fax

Practice location:
  • Phone: 601-708-8309
  • Fax: 601-708-8391
Mailing address:
  • Phone: 601-708-8390
  • Fax: 601-708-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: HAROLD INGRAM
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 601-420-0141