Reggie Richardson
Individual provider Active NPI Contractor · Irmo, SC
NPI 1124990957 · NPPES record last updated Sep 22, 2025
Key facts
- NPI
- 1124990957
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 105 Foxglove LN
Irmo, SC 29063-8394 - Phone
- (839) 205-6084
- NPI assigned
- Sep 22, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
105 Foxglove LN
Irmo, SC 29063-8394
Mailing address
105 Foxglove LN
Irmo, SC 29063-8394
Phone (839) 205-6084
Other providers in Irmo, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.