Provider Demographics
NPI:1225793656
Name:HAYNES, RACHEL (RDN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 SUMMERSTONE BND
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6520
Mailing Address - Country:US
Mailing Address - Phone:678-634-8620
Mailing Address - Fax:
Practice Address - Street 1:244 SUMMERSTONE BND
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6520
Practice Address - Country:US
Practice Address - Phone:678-634-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered