Provider Demographics
NPI:1700274214
Name:HAYNES NEUROSURGICA GROUP
Entity Type:Organization
Organization Name:HAYNES NEUROSURGICA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TREADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-787-8676
Mailing Address - Street 1:801 PRINCETON AVE SW
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1310
Mailing Address - Country:US
Mailing Address - Phone:205-787-8676
Mailing Address - Fax:205-785-7944
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:SUITE 310
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1310
Practice Address - Country:US
Practice Address - Phone:205-787-8676
Practice Address - Fax:205-785-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty