Individual
DEJAH DOMINIQUE HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2591 CANDLER RD, DECATUR, GA 30032-6502
(678) 209-2710
Mailing address
160 CLAIREMONT AVE STE 200, DECATUR, GA 30030-2546
(516) 421-2555
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
099114
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
222118476048
—
GA
Enumeration date
05/10/2022
Last updated
05/10/2022
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