MEDICARE: AMY HAYNES MD

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	207Q00000X	Family Medicine Physician	30349	TN

General Provider Information

NPI Number	:	1871543926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY HAYNES MD

Provider Business Mailing Address
First Line	:	105 W STONE DR
Second Line	:	SUITE 6A
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3365
Country	:	US
Telephone Number	:	423-408-7220
Fax Number	:	423-408-7405

Provider Business Practice Location Address
First Line	:	405 SCENIC DR
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-2441
Country	:	US
Telephone Number	:	423-272-2111
Fax Number	:	423-272-7667

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/28/2014

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