JUDD M REYNOLDS (NPI# 1730355967) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730355967 |
| Entity Type | Individual |
| Full Name | JUDD M REYNOLDS |
| Credential | D.O. |
| Practice Address |
50 Parkway Ln Petal MS 39465-3035 |
| Mailing Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6017052897 |
| Practice Fax Number | 6015795240 |
| Mailing Telephone | 6017052897 |
| Mailing Fax Number | 6015795463 |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2020-08-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 24473 | MS | Allopathic & Osteopathic Physicians |
| N | 224Z00000X | Occupational Therapy Assistant | TA2169 | MS | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09807844 | 05 |
| Street Address |
50 PARKWAY LN |
| City | PETAL |
| State | MS |
| Zip Code | 39465-3035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497761241 | Donald V Conerly | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-08-01 |
| 1497162234 | Hattiesburg Clinic, Pa | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2014-07-14 |
| 1528339918 | Lori Leblanc Grundy | Physician Assistant | 50 Parkway Ln, Petal, MS 39465-3035 | 2012-01-18 |
| 1891941241 | Misty Walker Cagle | Nurse Practitioner | 50 Parkway Ln, Petal, MS 39465-3035 | 2008-08-15 |
| 1124117171 | George Gillespie IIi | Emergency Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-10-11 |
| 1831299130 | Hattiesburg Clinic Pa | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-09-25 |
| 1851400410 | Keith M Simnicht | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-08-29 |
| 1215042635 | Rodney N Lovitt | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-08-19 |
| 1114930468 | Robert F Heath | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164055489 | R&p Elite Services, LLC | Private Vehicle | 68 Springfield Rd., Petal, MS 39465 | 2020-02-14 |
| 1003460544 | Hayden White | Pharmacist | 36 Byrd Dr., Petal, MS 39465 | 2019-08-01 |
| 1134612971 | Chandler Mccarley Hawkins | Dentist | 1115 Evelyn Gandy Parkway, Petal, MS 39465 | 2018-06-06 |
| 1881199818 | Lauren O'neal Garner | Nurse Practitioner | 36 Stadium Drive, Petal, MS 39465 | 2018-03-30 |
| 1700036928 | Petal School District | Registered Nurse | 60 Herrington Road, Petal, MS 39465 | 2008-09-24 |
| 1962679043 | Hattiesburg Eye Clinic Pa | Optometrist | 1223 Hwy 42, Ste 140, Petal, MS 39465 | 2008-05-08 |
| 1023228640 | Noal Baxter Cochran | Marriage & Family Therapist | 80 Lakeland Circle, Petal, MS 39465 | 2007-05-23 |
| 1750596938 | James A Nicholson Dds Pa | Dentist | 120 South 28th Avenue, Hattiesburg, MS 39465 | 2007-05-11 |
| 1356563605 | Petal School District | Registered Nurse | 400 Hillcrest Loop, Petal, MS 39465 | 2007-05-03 |
| 1154480804 | Mary E Thomsen | Orthotic Fitter | 173 Cherry Oak Trail, Petal, MS 39465 | 2006-12-08 |
| Find all providers in zip 39465 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497761241 | Donald V Conerly | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-08-01 |
| 1588608509 | Robert Michael Weaver | Family Medicine | 1146 Evelyn Gandy Pkwy, Petal, MS 39465 | 2006-06-16 |
| 1497162234 | Hattiesburg Clinic, Pa | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2014-07-14 |
| 1700197977 | Heather Elizabeth Waters | Family Medicine | 1146 Evelyn Gandy Pkwy, Petal, MS 39465 | 2010-06-23 |
| 1649356767 | Hattiesburg Clinic Pa | Family Medicine | 15 Pumping Station Rd, Petal, MS 39465-8325 | 2006-10-31 |
| 1831299130 | Hattiesburg Clinic Pa | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-09-25 |
| 1851400410 | Keith M Simnicht | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-08-29 |
| 1215042635 | Rodney N Lovitt | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-08-19 |
| 1114930468 | Robert F Heath | Family Medicine | 50 Parkway Ln, Petal, MS 39465-3035 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900581 | Maegan Cook Bridges | Family Medicine | 312 Ridge Pointe Dr, Brandon, MS 39042-5035 | 2020-10-24 |
| 1003415266 | Christian Fortenberry | Family Medicine | 786 Lake Harbour Dr, Ridgeland, MS 39157-4303 | 2020-10-20 |
| 1457967226 | Tiffine Lynn Prisock | Family Medicine | 24978 Ms-15, Mathiston, MS 39752 | 2020-09-17 |
| 1851902860 | Jasmine Lester | Family Medicine | 538 Getwell Rd S, Hernando, MS 38632-9585 | 2020-08-12 |
| 1942810569 | Ericka Marcene Williams | Family Medicine | 1031 Northridge Rd Ste A, Baldwyn, MS 38824-1173 | 2020-08-07 |
| 1316557986 | Independent Healthcare Management, Inc | Family Medicine | 376 Simpson Highway 149 Ste 600, Magee, MS 39111-3572 | 2020-08-07 |
| 1164031373 | Rohith Reddy Guduru Venkata | Family Medicine | Delta Regional Medical Center, 1400 E Union St, Greenville, MS 38703 | 2020-07-24 |
| 1831707470 | Rebecca Holmes | Family Medicine | 42 Atley Holmes Rd # Rs, Jayess, MS 39641-8272 | 2020-07-20 |
| 1497373344 | Dhruval Patel | Family Medicine | 564 Cypress Ln Apt 11d, Greenville, MS 38701-7415 | 2020-07-08 |
| 1881211258 | Tiffany Chapman | Family Medicine | 905 S Frontage Rd, Meridian, MS 39301-6113 | 2020-07-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.