Healthcare Provider Details

I. General information

NPI: 1225025158
Provider Name (Legal Business Name): RALPH HAYGOOD JOHNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451A E SAINT JOHN ST
SPARTANBURG SC
29302-1623
US

IV. Provider business mailing address

451A E SAINT JOHN ST
SPARTANBURG SC
29302-1623
US

V. Phone/Fax

Practice location:
  • Phone: 864-591-0311
  • Fax: 864-591-0744
Mailing address:
  • Phone: 864-591-0311
  • Fax: 864-591-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number17001
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: