Provider Demographics
NPI:1356540264
Name:HYNES, JOHN DEWEY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DEWEY
Last Name:HYNES
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 1:201 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6522
Mailing Address - Country:US
Mailing Address - Phone:888-467-1117
Mailing Address - Fax:
Practice Address - Street 1:201 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6522
Practice Address - Country:US
Practice Address - Phone:888-467-1117
Practice Address - Fax:855-786-6996
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18894208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6613Medicaid