MEDICARE: DR. GWENETH MARTIN HAYES PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY003076	GA

General Provider Information

NPI Number	:	1417172578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GWENETH MARTIN HAYES PH.D.

Provider Business Mailing Address
First Line	:	7561 PETAL PL
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1974
Country	:	US
Telephone Number	:	678-755-4102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 CLEVELAND AVE
Second Line	:	SUITE 84
City	:	EAST POINT
State	:	GA
Zip	:	30344-6965
Country	:	US
Telephone Number	:	678-904-2869
Fax Number	:	404-506-9820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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