Provider Demographics
NPI:1366968083
Name:HAYNES, JASON RICHARD
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:RICHARD
Last Name:HAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 OLD SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-7650
Mailing Address - Country:US
Mailing Address - Phone:205-522-4425
Mailing Address - Fax:205-387-8589
Practice Address - Street 1:137 OLD SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-7650
Practice Address - Country:US
Practice Address - Phone:205-522-4425
Practice Address - Fax:205-387-8589
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)