Provider Demographics
NPI:1326795030
Name:HAIGLER, GREGORY ANTONIO
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ANTONIO
Last Name:HAIGLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 BELLEVIEW ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1871
Mailing Address - Country:US
Mailing Address - Phone:561-512-6797
Mailing Address - Fax:
Practice Address - Street 1:1103 BELLEVIEW ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1871
Practice Address - Country:US
Practice Address - Phone:561-512-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCBL001725-08-2021374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide