Provider Demographics
NPI:1942524459
Name:HAYNES, GEORGE R
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:R
Last Name:HAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3382 PINE MEADOW DR SE
Mailing Address - Street 2:UNIT 101
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-3056
Mailing Address - Country:US
Mailing Address - Phone:616-365-5108
Mailing Address - Fax:616-214-7735
Practice Address - Street 1:3382 PINE MEADOW DR SE
Practice Address - Street 2:UNIT 101
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-3056
Practice Address - Country:US
Practice Address - Phone:616-365-5108
Practice Address - Fax:616-214-7735
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942524459OtherNPI