=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346714524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL HAYNIA APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2019
-----------------------------------------------------
Last Update Date | 01/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 987 SAINT SEBASTIAN WAY
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30912-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-721-7930
-----------------------------------------------------
Fax | 706-721-8206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2820 OLD NINETY SIX INDIAN TRAIL
-----------------------------------------------------
City | WAGENER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-681-3962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN247670
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------