Healthcare Provider Details

I. General information

NPI: 1124198056
Provider Name (Legal Business Name): PATRICIA R HAYNES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PIEDMONT AVE NE SUITE 800
ATLANTA GA
30303-2401
US

IV. Provider business mailing address

75 PIEDMONT AVE NE SUITE 800
ATLANTA GA
30303-2544
US

V. Phone/Fax

Practice location:
  • Phone: 404-688-9305
  • Fax: 404-688-0621
Mailing address:
  • Phone: 404-688-9305
  • Fax: 404-688-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number018071
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: