Healthcare Provider Details

I. General information

NPI: 1689739948
Provider Name (Legal Business Name): PENNY A. HAYS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3178 BOLERO WAY
ATLANTA GA
30341-5762
US

IV. Provider business mailing address

3178 BOLERO WAY
ATLANTA GA
30341-5762
US

V. Phone/Fax

Practice location:
  • Phone: 770-414-0098
  • Fax: 770-414-6959
Mailing address:
  • Phone: 770-414-0098
  • Fax: 770-414-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: