Provider Demographics
NPI:1962430546
Name:HAGGARD, CLINTON R (ATC, LAT, NREMT-B)
Entity type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:R
Last Name:HAGGARD
Suffix:
Gender:M
Credentials:ATC, LAT, NREMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 GEORGE ROGERS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29208-0001
Mailing Address - Country:US
Mailing Address - Phone:803-777-5574
Mailing Address - Fax:803-777-8286
Practice Address - Street 1:1125 GEORGE ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-5574
Practice Address - Fax:803-777-8286
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8362146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic