Provider Demographics
NPI:1952468860
Name:HAYNES, STACY JEANENE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:JEANENE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:JEANENE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3825 LORNA RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3005
Mailing Address - Country:US
Mailing Address - Phone:256-831-8100
Mailing Address - Fax:256-831-8128
Practice Address - Street 1:3825 LORNA RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3005
Practice Address - Country:US
Practice Address - Phone:256-831-8100
Practice Address - Fax:256-831-8128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15551207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051007669OtherBCBS
AL000089332Medicaid
AL051007695OtherBCBS
ALE91043Medicare UPIN
AL000007669Medicare PIN