Healthcare Provider Details

I. General information

NPI: 1609573757
Provider Name (Legal Business Name): DERMATOLOGY HOUSE CALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N MAIN ST STE 12
ANDERSON SC
29621-5544
US

IV. Provider business mailing address

821 N MAIN ST STE 12
ANDERSON SC
29621-5544
US

V. Phone/Fax

Practice location:
  • Phone: 864-365-6405
  • Fax: 833-471-5951
Mailing address:
  • Phone: 864-365-6405
  • Fax: 833-471-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID HAYNIE FANT JR.
Title or Position: PRACTICE MANAGER
Credential:
Phone: 864-365-6291