Healthcare Provider Details

I. General information

NPI: 1023549698
Provider Name (Legal Business Name): WILLIAM MILES REEVES IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SPRINGVIEW LN
SUMMERVILLE SC
29485-8154
US

IV. Provider business mailing address

83 SPRINGVIEW LN
SUMMERVILLE SC
29485-8154
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-3664
  • Fax: 843-820-1007
Mailing address:
  • Phone: 843-797-3664
  • Fax: 843-820-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number009127
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number85420
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: