MEDICARE: DR. KWANNA VERNITA HAYES MD

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	2084P0800X	Psychiatry Physician	200S01946	NC

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	:	1487768404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWANNA VERNITA HAYES MD

Provider Business Mailing Address
First Line	:	5454 YORKTOWNE DR
Second Line	:	SOUTHERN CRESCENT BEHAVIORAL HEALTH SYSTEM
City	:	ATLANTA
State	:	GA
Zip	:	30349-5317
Country	:	US
Telephone Number	:	678-251-3202
Fax Number	:	770-997-2757

Provider Business Practice Location Address
First Line	:	5454 YORKTOWNE DR
Second Line	:	SOUTHERN CRESCENT BEHAVIORAL HEALTH SYSTEM
City	:	ATLANTA
State	:	GA
Zip	:	30349-5317
Country	:	US
Telephone Number	:	678-251-3202
Fax Number	:	770-997-2757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/15/2013

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