Provider Demographics
NPI:1477651917
Name:HAYES, LAURA JOANNA (EDD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JOANNA
Last Name:HAYES
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 BELLS FERRY RD NW STE 134
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1750
Mailing Address - Country:US
Mailing Address - Phone:770-977-9201
Mailing Address - Fax:877-656-2843
Practice Address - Street 1:2501 E PIEDMONT RD STE 103
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-7753
Practice Address - Country:US
Practice Address - Phone:770-977-9201
Practice Address - Fax:877-656-2843
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001364103T00000X
GA001364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000448984CMedicaid
GA000448984BMedicaid
GA000448984BMedicaid