Healthcare Provider Details

I. General information

NPI: 1124721204
Provider Name (Legal Business Name): AKHIL REDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AKHIL REDDYREDDY REDDY

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WELLNESS WAY
FORT MILL SC
29715-7315
US

IV. Provider business mailing address

222 HERLONG AVE S
ROCK HILL SC
29732-1158
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-3662
  • Fax:
Mailing address:
  • Phone: 972-942-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number97495
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: