Provider Demographics
NPI:1609228923
Name:BIRCH, HAYDEN S (LMT#005369)
Entity Type:Individual
Prefix:MR
First Name:HAYDEN
Middle Name:S
Last Name:BIRCH
Suffix:
Gender:M
Credentials:LMT#005369
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 14TH ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3696
Mailing Address - Country:US
Mailing Address - Phone:678-517-1554
Mailing Address - Fax:
Practice Address - Street 1:244 14TH ST NE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3696
Practice Address - Country:US
Practice Address - Phone:678-517-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT#005369172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist