Healthcare Provider Details

I. General information

NPI: 1891365722
Provider Name (Legal Business Name): CRYSTAL LYNN HAYNES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 HIGHWAY 34 E
NEWNAN GA
30265-1329
US

IV. Provider business mailing address

2305 HIGHWAY 34 E
NEWNAN GA
30265-1329
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-1043
  • Fax:
Mailing address:
  • Phone: 678-423-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number283665
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1204410
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021502
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHAYN-8BY7U
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP001323
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-3219
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: