Provider Demographics
NPI:1295783272
Name:HAYNES, MACKIE LEE (APRN)
Entity type:Individual
Prefix:
First Name:MACKIE
Middle Name:LEE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41 WELLINGTON MILL RD
Mailing Address - Street 2:POB 339
Mailing Address - City:WHITESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30185-2606
Mailing Address - Country:US
Mailing Address - Phone:770-836-0504
Mailing Address - Fax:770-834-8261
Practice Address - Street 1:41 WELLINGTON MILL RD
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:GA
Practice Address - Zip Code:30185-2606
Practice Address - Country:US
Practice Address - Phone:770-836-0504
Practice Address - Fax:770-834-8261
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN045227NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner