Provider Demographics
NPI:1326008616
Name:HAYES, FRUSANNA BOOTH (EDD)
Entity Type:Individual
Prefix:DR
First Name:FRUSANNA
Middle Name:BOOTH
Last Name:HAYES
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CONFEDERATE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-2252
Mailing Address - Country:US
Mailing Address - Phone:706-342-3130
Mailing Address - Fax:
Practice Address - Street 1:1200 CONFEDERATE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2252
Practice Address - Country:US
Practice Address - Phone:706-342-3130
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1024103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00321791BMedicaid