Healthcare Provider Details

I. General information

NPI: 1063436103
Provider Name (Legal Business Name): WILLIAM B HAYNES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 HOSPITAL PKWY STE 302
JOHNS CREEK GA
30097-5712
US

IV. Provider business mailing address

2065 SOUTHERS CIR
SUWANEE GA
30024-5487
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-8111
  • Fax: 678-990-1956
Mailing address:
  • Phone: 678-513-8111
  • Fax: 678-990-1956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35897
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: