MEDICARE: HAILEY DENISE SPIRES MS, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LRD.1948	SC

General Provider Information

NPI Number	:	1083210975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY DENISE SPIRES MS, RD, LD

Provider Business Mailing Address
First Line	:	117 HIGHGROVE CIR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-3846
Country	:	US
Telephone Number	:	803-767-9177
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 HIGHGROVE CIR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-3846
Country	:	US
Telephone Number	:	803-767-9177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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