Healthcare Provider Details

I. General information

NPI: 1306598925
Provider Name (Legal Business Name): ASHLEY DANIELLE HAYNES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 BREEDLOVE DR STE B
MONROE GA
30655-2054
US

IV. Provider business mailing address

1127 COLEMAN FARM RD
RENTZ GA
31075-3507
US

V. Phone/Fax

Practice location:
  • Phone: 888-772-0076
  • Fax: 770-751-8014
Mailing address:
  • Phone: 478-697-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN258912
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: