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NPI Code Detail

MEDICARE: JASON R HAYNES NCC

MEDICARE: JASON R HAYNES NCC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1710526967
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON R HAYNES NCC
Provider Business Mailing Address
First Line : 825 HIGHLAND LN NE APT 1206
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4338
Country : US
Telephone Number : 404-314-4834
Fax Number :
Provider Business Practice Location Address
First Line : 3754 LAVISTA RD STE 200
Second Line :
City : TUCKER
State : GA
Zip : 30084-5627
Country : US
Telephone Number : 770-810-5789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2020
Last Update Date : 01/04/2020

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Directions to “ JASON R HAYNES NCC” Practice Location

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