Provider Demographics
NPI:1063655892
Name:HAYES, TERRI (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 HIGHWAY 5
Mailing Address - Street 2:SUITE 335
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2308
Mailing Address - Country:US
Mailing Address - Phone:770-369-7527
Mailing Address - Fax:
Practice Address - Street 1:3318 HIGHWAY 5
Practice Address - Street 2:SUITE 335
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2308
Practice Address - Country:US
Practice Address - Phone:770-369-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA203380462DMedicaid