Provider Demographics
NPI:1134327141
Name:GREGORY D. HAYNES, MD P.C.
Entity Type:Organization
Organization Name:GREGORY D. HAYNES, MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-572-1770
Mailing Address - Street 1:401 MULBERRY ST SW
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5463
Mailing Address - Country:US
Mailing Address - Phone:828-572-1770
Mailing Address - Fax:828-572-1763
Practice Address - Street 1:401 MULBERRY ST SW
Practice Address - Street 2:SUITE 206
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5463
Practice Address - Country:US
Practice Address - Phone:828-572-1770
Practice Address - Fax:828-572-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00455207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2628362Medicaid
NC5909243Medicaid
MI2628362Medicaid
MI0P08780Medicare PIN
MIE25916Medicare UPIN