Healthcare Provider Details

I. General information

NPI: 1750012993
Provider Name (Legal Business Name): MAURICE RANDALL HOOK MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 COLONIAL DR
COLUMBIA SC
29203-6818
US

IV. Provider business mailing address

10 CASEY DR
ELGIN SC
29045-7001
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-1555
  • Fax: 803-898-2194
Mailing address:
  • Phone: 765-541-3293
  • Fax: 803-898-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: