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General NPI Number Information
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NPI Number | 1417172578
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Entity Type | Individual
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Provider Name | GWENETH MARTIN HAYES PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1514 CLEVELAND AVE SUITE 84
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City | EAST POINT
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State | GA
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Zip | 30344-6965
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Country | US
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Telephone | 678-904-2869
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Fax | 404-506-9820
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Provider Business Mailing Address
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Address Line | 7561 PETAL PL
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City | FAIRBURN
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State | GA
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Zip | 30213-1974
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Country | US
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Telephone | 678-755-4102
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY003076
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License Number State | GA
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