Healthcare Provider Details

I. General information

NPI: 1518617190
Provider Name (Legal Business Name): JENNY LORE HALEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CALLEN BLVD STE 300
SUMMERVILLE SC
29486-3163
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-1800
  • Fax: 843-606-8036
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number97067
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: