Healthcare Provider Details

I. General information

NPI: 1255226858
Provider Name (Legal Business Name): EMMA HAYNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHARLOIS BLVD
WINSTON SALEM NC
27103-1522
US

IV. Provider business mailing address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3361
  • Fax:
Mailing address:
  • Phone: 704-295-3000
  • Fax: 704-295-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15633
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: