Healthcare Provider Details

I. General information

NPI: 1710908496
Provider Name (Legal Business Name): JOHN CHRISTIAN HAASIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BOILING SPRINGS ROAD SUITE 2700
SPARTANBURG SC
29303
US

IV. Provider business mailing address

PO BOX 6130
SPARTANBURG SC
29304-6130
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-0053
  • Fax: 864-583-0390
Mailing address:
  • Phone: 864-583-0053
  • Fax: 864-583-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number19459
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number9601331
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: