Individual
JACQUELINE DAVIS HAITHCOCK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
776 DANIEL ELLIS DR, CHARLESTON, SC 29412-3094
(843) 795-8100
(843) 762-3010
Mailing address
776 DANIEL ELLIS DR, CHARLESTON, SC 29412-3094
(843) 795-8100
(843) 762-3010
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
16814
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3214
—
SC
Enumeration date
05/20/2006
Last updated
07/09/2007
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