Healthcare Provider Details

I. General information

NPI: 1568550937
Provider Name (Legal Business Name): AMY HAIRSTON CROCKETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY HAIRSTON PICKLESIMER M.D.

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W FARIS RD STE 470
GREENVILLE SC
29605-4281
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-1600
  • Fax: 864-455-3095
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number29528
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: