Provider Demographics
NPI:1851341317
Name:HAYNES, WILLIAM WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
Last Name:HAYNES
Suffix:
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 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:415D ROBERTSON BLVD
Practice Address - Street 2:W WALTER HAYNES
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488
Practice Address - Country:US
Practice Address - Phone:843-549-8444
Practice Address - Fax:843-549-8499
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00739553OtherRAILROAD MEDICARE ID-RSFPN
SC080182205OtherRR MEDICARE
SC084250Medicaid
SCD992718145Medicare PIN
SC080182205OtherRR MEDICARE
SCD99271Medicare UPIN
SCP00739553OtherRAILROAD MEDICARE ID-RSFPN
SC1235189259Medicare PIN
SCD992716795Medicare PIN