Healthcare Provider Details

I. General information

NPI: 1154492155
Provider Name (Legal Business Name): AVA CARROLL HAYMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: A CARROLL HAYMON MD

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S 324TH ST STE B207
FEDERAL WAY WA
98003-8444
US

IV. Provider business mailing address

1 EMBARCADERO CTR FL 19
SAN FRANCISCO CA
94111-3628
US

V. Phone/Fax

Practice location:
  • Phone: 253-220-3121
  • Fax: 415-252-7176
Mailing address:
  • Phone:
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number101204
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD00041490
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00041490
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: