Provider Demographics
NPI:1063436103
Name:HAYNES, WILLIAM B JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:HAYNES
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2065 SOUTHERS CIR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5487
Mailing Address - Country:US
Mailing Address - Phone:678-513-8111
Mailing Address - Fax:678-990-1956
Practice Address - Street 1:6335 HOSPITAL PKWY STE 302
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5712
Practice Address - Country:US
Practice Address - Phone:678-513-8111
Practice Address - Fax:678-990-1956
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-11-21
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Provider Licenses
StateLicense IDTaxonomies
GA35897207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I201823Medicare PIN
E39212Medicare UPIN
GAE39212Medicare UPIN
GA005166451Medicaid