Healthcare Provider Details

I. General information

NPI: 1861338147
Provider Name (Legal Business Name): HAYLEY LOREE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 S BRANNON STAND RD
DOTHAN AL
36305-7005
US

IV. Provider business mailing address

9631 S COUNTY ROAD 49
SLOCOMB AL
36375-5836
US

V. Phone/Fax

Practice location:
  • Phone: 334-618-6809
  • Fax:
Mailing address:
  • Phone: 334-618-6809
  • Fax: 334-801-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-428501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: