Healthcare Provider Details

I. General information

NPI: 1003856287
Provider Name (Legal Business Name): WILLIAM DANA HAITHCOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 VALLEYGATE DR SUITE 101
FAYETTEVILLE NC
28304-3688
US

IV. Provider business mailing address

2029 VALLEYGATE DR SUITE 101
FAYETTEVILLE NC
28304-3688
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-2103
  • Fax: 910-323-2219
Mailing address:
  • Phone: 910-323-2103
  • Fax: 910-323-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number22303
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: