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General NPI Number Information
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NPI Number | 1740611474
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Entity Type | Organization
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Legal Business Name | GILL REYNOLDS-PRIDGETT
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 12 PERIMETER PARK S
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City | BIRMINGHAM
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State | AL
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Zip | 35243-2326
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Country | US
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Telephone | 866-559-5735
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Fax | 866-558-2242
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Provider Business Mailing Address
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Address Line | 1320 MAIN ST
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City | COLUMBIA
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State | SC
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Zip | 29201-3204
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Country | US
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Telephone | 866-559-5735
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Fax | 866-558-2242
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GILL REYNOLDS-PRIDGETT
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Credential | CEO
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Telephone | 18665595735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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