Provider Demographics
NPI:1750769014
Name:HAYNES, EMILY ANNA (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNA
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BREAKERS DR
Mailing Address - Street 2:APT 332
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4423
Mailing Address - Country:US
Mailing Address - Phone:330-247-8295
Mailing Address - Fax:
Practice Address - Street 1:2233 NORTHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4007
Practice Address - Country:US
Practice Address - Phone:843-773-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2317363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical