Provider Demographics
NPI:1225190036
Name:HAYNES, MARK (RETAIL FURNITURE)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HAYNES
Suffix:
Gender:M
Credentials:RETAIL FURNITURE
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:DANIEL
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OWNER
Mailing Address - Street 1:5089 TAMMY LITTLE DR
Mailing Address - Street 2:
Mailing Address - City:SECTION
Mailing Address - State:AL
Mailing Address - Zip Code:35771-7244
Mailing Address - Country:US
Mailing Address - Phone:256-228-3577
Mailing Address - Fax:256-228-3577
Practice Address - Street 1:5089 TAMMY LITTLE DR
Practice Address - Street 2:
Practice Address - City:SECTION
Practice Address - State:AL
Practice Address - Zip Code:35771-7244
Practice Address - Country:US
Practice Address - Phone:256-228-3577
Practice Address - Fax:256-228-3577
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies