MEDICARE: DR. JAMES W. HAYNES M.D.

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	207Q00000X	Family Medicine Physician	036-105232	IL
2	207Q00000X	Family Medicine Physician	47422	TN

General Provider Information

NPI Number	:	1558359448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES W. HAYNES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 11023
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37401
Country	:	US
Telephone Number	:	423-778-3274
Fax Number	:	423-778-2255

Provider Business Practice Location Address
First Line	:	1100 EAST THIRD ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2241
Country	:	US
Telephone Number	:	423-778-8837
Fax Number	:	423-778-9301

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	06/23/2011

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