Provider Demographics
NPI:1306036652
Name:JULIA S HAILE MD INFECTIOUS DISEASE PA
Entity type:Organization
Organization Name:JULIA S HAILE MD INFECTIOUS DISEASE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-556-2651
Mailing Address - Street 1:PO BOX 890484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0484
Mailing Address - Country:US
Mailing Address - Phone:843-556-5621
Mailing Address - Fax:
Practice Address - Street 1:635 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7174
Practice Address - Country:US
Practice Address - Phone:843-556-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24357207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4715Medicaid
SC8804Medicare PIN