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General NPI Number Information
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NPI Number | 1619171709
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Entity Type | Individual
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Provider Name | SCOTTY JACK HAYNES MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 1113 MURFREESBORO RD SUITE 106, #343
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City | FRANKLIN
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State | TN
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Zip | 37064-1306
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Country | US
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Telephone | 615-550-7127
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Fax | 855-291-1894
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Provider Business Mailing Address
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Address Line | 1113 MURFREESBORO RD SUITE 106, #343
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City | FRANKLIN
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State | TN
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Zip | 37064-1306
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Country | US
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Telephone | 615-550-7127
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Fax | 855-291-1894
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD45839
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License Number State | TN
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