Provider Demographics
NPI:1033172648
Name:HAYES, EDWARD ELAM (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ELAM
Last Name:HAYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2301 BELLEVUE RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2557
Mailing Address - Country:US
Mailing Address - Phone:478-272-5598
Mailing Address - Fax:478-272-2061
Practice Address - Street 1:2301 BELLEVUE RD STE 1000
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2557
Practice Address - Country:US
Practice Address - Phone:478-272-5598
Practice Address - Fax:478-272-2061
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69475208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
562251157OtherTAX ID
GA003137861AMedicaid