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General NPI Number Information
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NPI Number | 1699666784
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Entity Type | Individual
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Provider Name | SUSAN L HAYNES
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Gender | Female
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 125 PLANTATION CENTRE DR S
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City | MACON
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State | GA
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Zip | 31210-2079
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Country | US
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Telephone | 800-650-8797
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Fax | 800-650-8797
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Provider Business Mailing Address
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Address Line | 125 PLANTATION CENTRE DR S
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City | MACON
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State | GA
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Zip | 31210-2079
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Country | US
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Telephone | 478-258-3431
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Fax | 800-650-8797
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 100044
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 100044
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License Number State | GA
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