Provider Demographics
NPI:1104810274
Name:HAYNES, JAMES BREVARD (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BREVARD
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:BREVARD
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:SUITE G-8
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-284-7533
Mailing Address - Fax:615-224-7575
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:SUITE G-8
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-7533
Practice Address - Fax:615-224-7575
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9739207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0054033OtherBLUE CROSS BLUE SHIELD
TN3378687Medicaid
TN4082376OtherAETNA PROVIDER NUMBER
TN3378687Medicare ID - Type Unspecified