Provider Demographics
NPI:1124700653
Name:HAYNES, LATOYA (LPN)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5701 MABLETON PKWY SW STE 310
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3360
Mailing Address - Country:US
Mailing Address - Phone:678-799-1203
Mailing Address - Fax:
Practice Address - Street 1:5701 MABLETON PKWY SW STE 310
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3360
Practice Address - Country:US
Practice Address - Phone:678-799-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN091006164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse