MEDICARE: KENNETH J HAYLES MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	09714	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033208129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH J HAYLES MD PA

Provider Business Mailing Address
First Line	:	1550 MEDICAL PARK 1
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7239
Country	:	US
Telephone Number	:	662-335-6010
Fax Number	:	662-335-6208

Provider Business Practice Location Address
First Line	:	1550 MEDICAL PARK 1
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7239
Country	:	US
Telephone Number	:	662-335-6010
Fax Number	:	662-335-6208

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	KENNETH J HAYLES
Credential	:	M.D.
Telephone Number	:	662-335-6010

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/02/2007

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