Healthcare Provider Details

I. General information

NPI: 1235102963
Provider Name (Legal Business Name): DOUGLAS BRANDT HAYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 OAK PARK
MC MINNVILLE TN
37110-1336
US

IV. Provider business mailing address

207 OAK PARK
MC MINNVILLE TN
37110-1336
US

V. Phone/Fax

Practice location:
  • Phone: 931-473-9624
  • Fax: 931-473-7718
Mailing address:
  • Phone: 931-473-9624
  • Fax: 931-473-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD10334
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: