Provider Demographics
NPI:1720363732
Name:HAYES, DEBORAH O (CST/CSFA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:O
Last Name:HAYES
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 OXBOTTOM DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6359
Mailing Address - Country:US
Mailing Address - Phone:229-247-5686
Mailing Address - Fax:229-247-5584
Practice Address - Street 1:4620 OXBOTTOM DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6359
Practice Address - Country:US
Practice Address - Phone:229-247-5686
Practice Address - Fax:229-247-5584
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO129932246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant