Healthcare Provider Details

I. General information

NPI: 1053041707
Provider Name (Legal Business Name): JADE REID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HERLONG AVE S
ROCK HILL SC
29732-1158
US

IV. Provider business mailing address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-1234
  • Fax:
Mailing address:
  • Phone: 845-790-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number95252
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: