Phyllis Denise Haynes
Individual provider Active NPI Attendant Care Provider · Bogart, GA
NPI 1750992913 · NPPES record last updated Aug 12, 2020
Key facts
- NPI
- 1750992913
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Attendant Care Provider 3747A0650X
- Practice address
- 1111 Glenwood LN
Bogart, GA 30622-2396 - Phone
- (706) 202-1577
- NPI assigned
- Aug 12, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | Yes |
Addresses
Primary practice location
1111 Glenwood LN
Bogart, GA 30622-2396
Mailing address
1111 Glenwood LN
Bogart, GA 30622-2396
Phone (706) 202-1577
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3747A0650X | Other | PROVIDER |
Other providers in Bogart, GA
- Halifax EMS LLC
- Rachel W Hamil
- Kathleen Hamilton
- Hampton Valley Health Center, Inc.
- Christine S Harr
- Andrew Philip Heidesch
- Jana Heitmeyer
- Angela Held
- HMP Diagnostics, LLC
- Home Medical Professionals
All providers in Bogart, GA · Attendant Care Provider in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.