Provider Demographics
NPI:1710041983
Name:HAYNES, GAYE NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:GAYE
Middle Name:NICOLE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DR 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:
Practice Address - Street 1:2906 FRANKLIN PKWY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:GA
Practice Address - Zip Code:30217-7544
Practice Address - Country:US
Practice Address - Phone:706-675-6949
Practice Address - Fax:706-675-1962
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08CBBLFMedicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER
GAH60759Medicare UPIN