Active NPI
Jack Holmes Reid Jr.
- Periodontics
- Fairhope, AL
National Provider Identifier
1407043797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 3625
- Practice address
- 911 Plantation Blvd
Fairhope, AL 36532-2949 - Phone
- (251) 928-9331
- NPI assigned
- Oct 1, 2007
- Last updated
- Oct 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 3625 | AL | Primary |
Addresses
Primary practice location
911 Plantation Blvd
Fairhope, AL 36532-2949
Mailing address
911 Plantation Blvd
Fairhope, AL 36532-2949
Phone (251) 928-9331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3625 | AL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191196800000",
"number": "1407043797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "911 PLANTATION BLVD",
"city": "FAIRHOPE",
"state": "AL",
"postal_code": "365322949",
"telephone_number": "251-928-9331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "911 PLANTATION BLVD",
"city": "FAIRHOPE",
"state": "AL",
"postal_code": "365322949",
"telephone_number": "251-928-9331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REID",
"first_name": "JACK",
"middle_name": "HOLMES",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-01",
"last_updated": "2007-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AL",
"license": "3625",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairhope, AL
- Chad David Reaves, DO
- Rajadhar Reddy, MD
- Patricia Reed, PMHNP-BC
- Refine PT and Performance - Fairhope LLC
- Rehab Associates, LLC (Champion Sports Medicine & Rehabilitation Cntr - Fairhope)
- Helen B Renner, MSW, LCSW
- Laurie Anne Repoll, P.T.
- Hoyt Harris Reynolds, M.D.
- Elizabeth Rezner, LMSW
- Lee D. Richards, CRNA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.