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NPI Code Detail

MEDICARE: YAJAIRA HAYGOOD PTA

MEDICARE: YAJAIRA HAYGOOD PTA
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
1225200000XPhysical Therapy AssistantPTA004510GA

General Provider Information

NPI Number : 1891303640
Entity Type Code : Individual
Provider Name (Legal Business Name) : YAJAIRA HAYGOOD PTA
Provider Business Mailing Address
First Line : 1965 TOMAHAWK LN
Second Line :
City : CUMMING
State : GA
Zip : 30028-3773
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1109 GREEN ST
Second Line :
City : ROSWELL
State : GA
Zip : 30075-3609
Country : US
Telephone Number : 877-787-3430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2020
Last Update Date : 08/04/2020

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