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General NPI Number Information
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NPI Number | 1548367089
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Entity Type | Organization
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Legal Business Name | GOLDEN ISLES VEIN INSTITUTE PC
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1015 ARTHUR J MOORE DR ISLAND HEALTH MEDICAL PARK
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522
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Country | US
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Telephone | 912-638-0411
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 683
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City | BRUNSWICK
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State | GA
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Zip | 31521
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Country | US
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Telephone | 912-638-0411
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRY L REYNOLDS
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Credential | MD
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Telephone | 912-638-0411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State | GA
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