Healthcare Provider Details

I. General information

NPI: 1093922023
Provider Name (Legal Business Name): BROOKE TAYLOR HAYNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE LOUISE TAYLOR M.D.

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 VILLAGE PROFESSIONAL DR S
OPELIKA AL
36801-4702
US

IV. Provider business mailing address

2401 VILLAGE PROFESSIONAL DR S
OPELIKA AL
36801-4702
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-8121
  • Fax: 334-749-6166
Mailing address:
  • Phone: 334-749-8121
  • Fax: 334-749-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29321
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: