Provider Demographics
NPI:1477651917
Name:HAYES, LAURA JOANNA (EDD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JOANNA
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-0700
Mailing Address - Country:US
Mailing Address - Phone:706-937-5180
Mailing Address - Fax:706-937-5183
Practice Address - Street 1:479 COTTER ST
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2337
Practice Address - Country:US
Practice Address - Phone:706-937-5180
Practice Address - Fax:706-937-5183
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000448984BMedicaid
GA68BBCPBMedicare PIN
GA000448984BMedicaid