Provider Demographics
NPI:1265625289
Name:HAYES, JASON THADEOUS (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:THADEOUS
Last Name:HAYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 HAYNES BRIDGE ROAD, SUITE 205-#305
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009
Mailing Address - Country:US
Mailing Address - Phone:678-395-7046
Mailing Address - Fax:678-395-3486
Practice Address - Street 1:10105 WESTSIDE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8806
Practice Address - Country:US
Practice Address - Phone:678-395-7046
Practice Address - Fax:678-395-3486
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6181207R00000X
LAMD.201342207R00000X
TN42706207R00000X, 207R00000X
GA69293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11809713OtherCAQH
GA003139410AMedicaid
TN3000862Medicare PIN
GA202I117464Medicare PIN
GA202I112382Medicare PIN
GA003139410BMedicaid