Provider Demographics
NPI:1578072674
Name:HAYNES, WILLIAM BRYCE III
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRYCE
Last Name:HAYNES
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MOREHEAD MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2966
Mailing Address - Country:US
Mailing Address - Phone:704-446-2772
Mailing Address - Fax:704-355-2467
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2966
Practice Address - Country:US
Practice Address - Phone:704-446-2772
Practice Address - Fax:704-355-2467
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program