Provider Demographics
NPI:1831969492
Name:HAYWARD, ANTIONETTE N (CPT)
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:N
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MANCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-7147
Mailing Address - Country:US
Mailing Address - Phone:912-532-9284
Mailing Address - Fax:
Practice Address - Street 1:303 MANCHESTER CT
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-7147
Practice Address - Country:US
Practice Address - Phone:912-532-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23-8408246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy