Healthcare Provider Details

I. General information

NPI: 1154413250
Provider Name (Legal Business Name): RODNEY R REID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY ROAD
COLUMBIA SC
29209
US

IV. Provider business mailing address

204 CLUB COLONY CIRCLE
BLYTHEWOOD SC
29016
US

V. Phone/Fax

Practice location:
  • Phone: 803-695-6818
  • Fax: 803-695-7905
Mailing address:
  • Phone: 803-691-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number14797
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: