Healthcare Provider Details

I. General information

NPI: 1699809434
Provider Name (Legal Business Name): ELIZABETH STOKELY HAILE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SUMMIT CENTRE DR
COLUMBIA SC
29229-7612
US

IV. Provider business mailing address

601 CLEMSON RD
COLUMBIA SC
29229-4341
US

V. Phone/Fax

Practice location:
  • Phone: 803-449-0007
  • Fax: 803-462-0312
Mailing address:
  • Phone: 803-788-6146
  • Fax: 803-462-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27140
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: