Basic Information
| Provider Information | |||||||||
| NPI: | 1710041983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYNES | ||||||||
| FirstName: | GAYE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 AMBULANCE DR 202 | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708388710 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2906 FRANKLIN PKWY | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302177544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066756949 | ||||||||
| FaxNumber: | 7066751962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 12/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 049696 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.