Healthcare Provider Details

I. General information

NPI: 1073780342
Provider Name (Legal Business Name): SALLY R HAYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 ROLLING RD STE IANDJ
SPRINGFIELD VA
22152-2307
US

IV. Provider business mailing address

6230 ROLLING RD STE IANDJ
SPRINGFIELD VA
22152-2307
US

V. Phone/Fax

Practice location:
  • Phone: 571-665-6460
  • Fax: 571-565-6561
Mailing address:
  • Phone: 571-665-6460
  • Fax: 571-565-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101263202
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01065000A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: