Provider Demographics
NPI:1003289240
Name:HAYNES, AKIALAH (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:AKIALAH
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24385
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-0385
Mailing Address - Country:US
Mailing Address - Phone:614-407-6751
Mailing Address - Fax:
Practice Address - Street 1:1768 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211
Practice Address - Country:US
Practice Address - Phone:614-407-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management