Healthcare Provider Details

I. General information

NPI: 1649677469
Provider Name (Legal Business Name): BRIDGET DAVIS HAYES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 LAKE VIEW RIDGE DR
LORIS SC
29569-8833
US

IV. Provider business mailing address

121 LAKE VIEW RIDGE DR
LORIS SC
29569-8833
US

V. Phone/Fax

Practice location:
  • Phone: 843-756-6503
  • Fax: 843-716-3501
Mailing address:
  • Phone: 843-756-6503
  • Fax: 843-716-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number100965
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: