Provider Demographics
NPI:1912148958
Name:HAYES, TANISHA (DO)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 TUSCAN AVE
Mailing Address - Street 2:WILLIAM CAREY UNIVERSITY-COM BOX 207
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-5461
Mailing Address - Country:US
Mailing Address - Phone:601-318-6749
Mailing Address - Fax:601-318-6032
Practice Address - Street 1:498 TUSCAN AVE
Practice Address - Street 2:WILLIAM CAREY UNIVERSITY-COM BOX 197
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5461
Practice Address - Country:US
Practice Address - Phone:601-318-6749
Practice Address - Fax:601-318-6032
Is Sole Proprietor?:No
Enumeration Date:2009-03-22
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012229207ZP0102X
VA0102202723207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology