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NPI Code Detail

MEDICARE: RICHARD HAYWARD

MEDICARE: RICHARD HAYWARD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician60745TN

General Provider Information

NPI Number : 1912391319
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD HAYWARD
Provider Business Mailing Address
First Line : 965 RIDGE LAKE BLVD STE 103
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-9446
Country : US
Telephone Number :
Fax Number : 901-227-8591
Provider Business Practice Location Address
First Line : 1600 BROWNS FERRY RD
Second Line :
City : MADISON
State : AL
Zip : 35758-9601
Country : US
Telephone Number : 256-461-7272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2015
Last Update Date : 09/23/2024

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