Provider Demographics
NPI:1275524514
Name:HUMPHRIES, HILIARY SEAY (MD)
Entity Type:Individual
Prefix:MRS
First Name:HILIARY
Middle Name:SEAY
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NORTH A ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640
Mailing Address - Country:US
Mailing Address - Phone:864-855-0001
Mailing Address - Fax:864-855-5030
Practice Address - Street 1:800 NORTH A ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2144
Practice Address - Country:US
Practice Address - Phone:864-855-0001
Practice Address - Fax:864-855-5030
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCI07861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC231948Medicaid
I07861Medicare UPIN