Provider Demographics
NPI:1235166968
Name:HINES, WILLIAM MANLEY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MANLEY
Last Name:HINES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MEDINAH DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3131
Mailing Address - Country:US
Mailing Address - Phone:864-306-9870
Mailing Address - Fax:
Practice Address - Street 1:305 MEDINAH DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3131
Practice Address - Country:US
Practice Address - Phone:864-306-9870
Practice Address - Fax:864-644-1078
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR00040035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered