Provider Demographics
NPI:1598721243
Name:HAYDEN, JOHN H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:HAYDEN
Suffix:JR
Gender:M
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:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1245
Mailing Address - Country:US
Mailing Address - Phone:803-395-4497
Mailing Address - Fax:803-536-0998
Practice Address - Street 1:1619 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4939
Practice Address - Country:US
Practice Address - Phone:803-531-7474
Practice Address - Fax:803-531-7457
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC423828OtherMEDICARE RHC
SCPC4116Medicaid
SCRHC151Medicaid
SCRHC020Medicaid
SC428926OtherMEDICARE RHC
SCRHC020Medicaid
SCRHC151Medicaid