Healthcare Provider Details

I. General information

NPI: 1700988623
Provider Name (Legal Business Name): SAMUEL HAZELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 SAVAGE RD
CHARLESTON SC
29407-4726
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-2835
  • Fax: 843-722-8948
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10048
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: