Provider Demographics
NPI:1073807061
Name:MARY HAYNES WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:MARY HAYNES WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LINNIE
Authorized Official - Middle Name:REED
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-550-0229
Mailing Address - Street 1:1283 BREEDLOVE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-1640
Mailing Address - Country:US
Mailing Address - Phone:901-550-0229
Mailing Address - Fax:901-794-7877
Practice Address - Street 1:5830 MOUNT MORIAH RD
Practice Address - Street 2:SUITE 18C
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1607
Practice Address - Country:US
Practice Address - Phone:901-550-0229
Practice Address - Fax:901-794-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11058261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service