Provider Demographics
NPI:1639712649
Name:HAYES, MARLANA (NP)
Entity Type:Individual
Prefix:
First Name:MARLANA
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 THORNTON RD STE 3-297
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-1518
Mailing Address - Country:US
Mailing Address - Phone:904-382-8911
Mailing Address - Fax:
Practice Address - Street 1:112 HEAD AVE
Practice Address - Street 2:
Practice Address - City:TALLAPOOSA
Practice Address - State:GA
Practice Address - Zip Code:30176-1219
Practice Address - Country:US
Practice Address - Phone:678-573-8004
Practice Address - Fax:470-987-6543
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF09190100363L00000X
GARNNP227300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner