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General NPI Number Information
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NPI Number | 1154123537
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Entity Type | Individual
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Provider Name | CRYSTAL-JADE HAUGHTON-REID MD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 101 E WOOD ST
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City | SPARTANBURG
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State | SC
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Zip | 29303-3040
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Country | US
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Telephone | 864-560-6285
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Fax |
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Provider Business Mailing Address
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Address Line | 112 GLENWOOD AVE
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City | BRIDGEPORT
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State | CT
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Zip | 06610-1631
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Country | US
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Telephone | 475-476-9728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LL94488
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License Number State | SC
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