Provider Demographics
NPI:1518938091
Name:HAYLES-PATTERSON, JACQULINE NAUDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQULINE
Middle Name:NAUDIA
Last Name:HAYLES-PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACQULINE
Other - Middle Name:NAUDIA
Other - Last Name:HAYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2775 CRUSE RD
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7140
Mailing Address - Country:US
Mailing Address - Phone:678-380-1200
Mailing Address - Fax:678-380-7494
Practice Address - Street 1:2775 CRUSE RD
Practice Address - Street 2:SUITE 2101
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7140
Practice Address - Country:US
Practice Address - Phone:678-380-1200
Practice Address - Fax:678-380-7494
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051329207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000976115BMedicaid
GAH95223Medicare UPIN
GA16BBCGPMedicare ID - Type Unspecified