Provider Demographics
NPI:1982659363
Name:HINNANT, CHARLES WILLIAM JR (MD JD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIAM
Last Name:HINNANT
Suffix:JR
Gender:M
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ESSEX DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3319
Mailing Address - Country:US
Mailing Address - Phone:864-226-6131
Mailing Address - Fax:864-225-0830
Practice Address - Street 1:112 ESSEX DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3319
Practice Address - Country:US
Practice Address - Phone:864-226-6131
Practice Address - Fax:864-226-2320
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15856SC208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC158563Medicaid
SC158563Medicaid