Healthcare Provider Details

I. General information

NPI: 1568476711
Provider Name (Legal Business Name): PETER C HAINES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PALMETTO HEALTH PKWY STE 100
COLUMBIA SC
29212-1761
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-907-7100
  • Fax: 803-907-7109
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number13063
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: