| Organization Name: | SOUTH WALTON MEDICAL GROUP |
| NPI Number: | 1457697278 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERRANCE ROLAND REEVES (OWNER PHYSICIAN) |
| Mailing Address: | 10065 Us Highway 98 W Ste B101 Miramar Beach |
| State: | FL US |
| Postal Code: | 325501902 |
| Phone Number: | 8508378005 |
| Fax Number: | 8508374352 |
| NPI Enumeration Date: | 12/26/2012 |
| NPI Last Update Date: | 06/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0401X |
| License Number: | FLME0067749 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A family medicine physician who specializes in the diagnosis and treatment of addictions. |