Provider Demographics
NPI:1447201124
Name:HAYWOOD, PATRICIA A (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:757 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4317
Mailing Address - Country:US
Mailing Address - Phone:678-442-1161
Mailing Address - Fax:678-442-9967
Practice Address - Street 1:757 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4317
Practice Address - Country:US
Practice Address - Phone:678-442-1161
Practice Address - Fax:678-442-9967
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist