Healthcare Provider Details

I. General information

NPI: 1073518486
Provider Name (Legal Business Name): ROSANNE J HOOKS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S MAIN ST
MULLINS SC
29574-3920
US

IV. Provider business mailing address

PO BOX 151
NICHOLS SC
29581-0151
US

V. Phone/Fax

Practice location:
  • Phone: 843-464-1201
  • Fax: 843-464-1219
Mailing address:
  • Phone: 843-464-1201
  • Fax: 843-464-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number110597
License Number StateSC

VIII. Authorized Official

Name: MR. WAYNE HOOKS
Title or Position: CFO
Credential:
Phone: 843-464-1201