Healthcare Provider Details

I. General information

NPI: 1154300424
Provider Name (Legal Business Name): CURTIS D. HASKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 FOLLY RD STE A
CHARLESTON SC
29412-2625
US

IV. Provider business mailing address

1124 SAM RITTENBERG BLVD SUITE 1
CHARLESTON SC
29407-3362
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-5362
  • Fax: 843-795-1921
Mailing address:
  • Phone: 843-556-3462
  • Fax: 843-766-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15474
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: