Provider Demographics
NPI:1437289865
Name:STACY J HAYNES MD PC
Entity Type:Organization
Organization Name:STACY J HAYNES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:JEANENE
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-831-8100
Mailing Address - Street 1:3825 LORNA RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3005
Mailing Address - Country:US
Mailing Address - Phone:256-831-8100
Mailing Address - Fax:256-831-8128
Practice Address - Street 1:3825 LORNA RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3005
Practice Address - Country:US
Practice Address - Phone:256-831-8100
Practice Address - Fax:256-831-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15551207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051007695OtherBCBS
AL051007669OtherBCBS
AL000089332Medicaid
ALE91043Medicare UPIN
ALJ310Medicare PIN