Provider Demographics
NPI:1700974045
Name:HAYES, ELOISE J (D O)
Entity Type:Individual
Prefix:DR
First Name:ELOISE
Middle Name:J
Last Name:HAYES
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 COLUMBIA RD
Mailing Address - Street 2:STE. 5A
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0401
Mailing Address - Country:US
Mailing Address - Phone:706-869-4175
Mailing Address - Fax:706-869-4179
Practice Address - Street 1:4210 COLUMBIA RD
Practice Address - Street 2:STE. 5A
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0401
Practice Address - Country:US
Practice Address - Phone:706-869-4175
Practice Address - Fax:706-869-4179
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003138924BMedicaid
GAGRP 2010Medicare ID - Type Unspecified
E96211Medicare UPIN
GAGRP 2010Medicare ID - Type Unspecified
OK200103990AMedicaid
OK242711501Medicare PIN