Provider Demographics
NPI:1043574882
Name:HAN, EARL JAMES (DO)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:JAMES
Last Name:HAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-652-8220
Mailing Address - Fax:843-652-8032
Practice Address - Street 1:2185 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-6418
Practice Address - Country:US
Practice Address - Phone:843-527-1800
Practice Address - Fax:843-527-6528
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020130207X00000X
KY04105207XX0005X
SC51970207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC519709Medicaid