Andre Vontral Haynes, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

68818 Issued in GA

Practice address

229 Rugged Creek Dr
Stockbridge, GA 30281-4568

Phone

(404) 783-0792

NPI assigned

Sep 28, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: andre.haynes@723419393884164.direct.elationemr.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543449600000",
    "number": "1174857940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 RUGGED CREEK DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 RUGGED CREEK DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814568",
            "telephone_number": "404-783-0792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "ANDRE",
        "middle_name": "VONTRAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-28",
        "last_updated": "2018-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AL",
            "license": "MD.29119",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "68818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas J. Hattermann, PT
• Clarisa Genay Haugabrook, M.D.
• Janet Martinez Haulk, PHARM.D.
• Patrick P Hawley, LCSW
• Brittany Hayes, CNA
• Deborah Elaine Haynes, M.D.
• Shonda Lankford Haynes, OTD, MS, MBA, OTR/L
• Jessica Haynie
• Jamie Shay Hays, PA, AA-C
• Yameika A Head, M.D.

• General Practice Physician in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.