Individual
PHYLLIS DENISE HAYNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 GLENWOOD LN, BOGART, GA 30622-2396
(706) 202-1577
Mailing address
1111 GLENWOOD LN, BOGART, GA 30622-2396
(706) 202-1577
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3747A0650X
PROVIDER
—
Enumeration date
08/12/2020
Last updated
08/12/2020
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