Mackie Lee Haynes, APRN
Individual provider Active NPI Nurse Practitioner · Whitesburg, GA
NPI 1295783272 · NPPES record last updated Dec 15, 2011
Key facts
- NPI
- 1295783272
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- RN045227NP (GA)
- Practice address
- 41 Wellington Mill Rd
Whitesburg, GA 30185-2606 - Phone
- (770) 836-0504
- Fax
- (770) 834-8261
- NPI assigned
- May 4, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150708002263 | GA | Order and Referring Only - Nurse Practitioner | 9638481351 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN045227NP | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bowdon- Mt. Zion Primary Health Center ,Inc. | Current | Accepting new patients |
Locations
41 Wellington Mill Rd
Whitesburg, GA 30185
Phone (770) 836-0504
Interoperability endpoints
- mackie.haynes1@gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN045227NP | GA | Yes |
Addresses
Primary practice location
41 Wellington Mill Rd
Whitesburg, GA 30185-2606
Mailing address
41 Wellington Mill Rd
Pob 339
Whitesburg, GA 30185-2606
Phone (770) 836-0504
Other providers in Whitesburg, GA
- Tomayria Brittian
- Deborah Davison
- Jeannie L Dollar
- Deborah M Flowers
- Amy Catherine Goodwin
- Jeannie L. Dollar
- Michella Catherine Jones
- Jessica Kearney
- Michelle Knott
- Marie S Oemler
All providers in Whitesburg, GA · Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.