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General NPI Number Information
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NPI Number | 1154492155
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Entity Type | Individual
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Provider Name | AVA CARROLL HAYMON MD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1414 S 324TH ST STE B207
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8444
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Country | US
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Telephone | 253-220-3121
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 1 EMBARCADERO CTR FL 19
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3628
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Country | US
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Telephone |
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Fax | 415-252-7176
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 101204
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | MD00041490
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00041490
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License Number State | WA
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