Provider Demographics
NPI:1326143900
Name:HALYARD, JEANNE LAIRD (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:LAIRD
Last Name:HALYARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:ANGELA
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1708 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3086
Mailing Address - Country:US
Mailing Address - Phone:843-248-4700
Mailing Address - Fax:843-248-3145
Practice Address - Street 1:1708 OAK ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3086
Practice Address - Country:US
Practice Address - Phone:843-248-4700
Practice Address - Fax:843-248-3145
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BL0561515OtherDEA NUMBER
BL0561515OtherDEA NUMBER