Provider Demographics
NPI:1043203326
Name:HAYES, GARY STEPHEN (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEPHEN
Last Name:HAYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4896 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3681
Mailing Address - Country:US
Mailing Address - Phone:423-942-3756
Mailing Address - Fax:423-942-7358
Practice Address - Street 1:4896 MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3681
Practice Address - Country:US
Practice Address - Phone:423-942-3756
Practice Address - Fax:423-942-7358
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18240208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3027961Medicaid
AL8705050Medicaid
TN3027961Medicaid
AL8705050Medicaid