Healthcare Provider Details

I. General information

NPI: 1689898074
Provider Name (Legal Business Name): WILLIAM LLOYD HAYES JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 MEADOWOOD LN
LONGS SC
29568-6523
US

IV. Provider business mailing address

2140 MEADOWOOD LN
LONGS SC
29568-6523
US

V. Phone/Fax

Practice location:
  • Phone: 843-399-8400
  • Fax:
Mailing address:
  • Phone: 843-399-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number057
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: