Provider Demographics
NPI:1225181712
Name:HAYNES, JON H (DDS)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:H
Last Name:HAYNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 MULKEY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1118
Mailing Address - Country:US
Mailing Address - Phone:770-941-8185
Mailing Address - Fax:770-941-8185
Practice Address - Street 1:1680 MULKEY RD
Practice Address - Street 2:SUITE F
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1118
Practice Address - Country:US
Practice Address - Phone:770-941-8185
Practice Address - Fax:770-941-8185
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics