Healthcare Provider Details

I. General information

NPI: 1326147190
Provider Name (Legal Business Name): CHARLOTTE A HAYES RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 OTTLEY DR NE
ATLANTA GA
30324-3925
US

IV. Provider business mailing address

900 LOST FOREST DR NW
ATLANTA GA
30328-2159
US

V. Phone/Fax

Practice location:
  • Phone: 404-419-3331
  • Fax: 404-872-9301
Mailing address:
  • Phone: 404-273-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD000980
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: