Provider Demographics
NPI:1902577570
Name:HAYNES, VALARIE ALESIA (RRT)
Entity type:Individual
Prefix:
First Name:VALARIE
Middle Name:ALESIA
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 ESTATE ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8847
Mailing Address - Country:US
Mailing Address - Phone:470-446-4260
Mailing Address - Fax:
Practice Address - Street 1:4501 ESTATE ST
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-8847
Practice Address - Country:US
Practice Address - Phone:470-446-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7918227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered