Provider Demographics
NPI:1629200464
Name:HAYNES MEDICAL CLINIC
Entity Type:Organization
Organization Name:HAYNES MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-407-9700
Mailing Address - Street 1:1009 EAST WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242
Mailing Address - Country:US
Mailing Address - Phone:731-407-9700
Mailing Address - Fax:731-641-7565
Practice Address - Street 1:1116 N MARKET ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-3206
Practice Address - Country:US
Practice Address - Phone:731-642-7060
Practice Address - Fax:731-641-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12936261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1932134871Medicare UPIN