Provider Demographics
NPI:1144330747
Name:HAYNES, GREGORY DELANO (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DELANO
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MULBERRY ST SW
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5463
Mailing Address - Country:US
Mailing Address - Phone:828-572-1770
Mailing Address - Fax:828-572-1763
Practice Address - Street 1:401 MULBERRY ST SW
Practice Address - Street 2:SUITE 206
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5463
Practice Address - Country:US
Practice Address - Phone:828-572-1770
Practice Address - Fax:828-572-1763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2628362Medicaid
MIOP08780Medicare ID - Type Unspecified
MI2628362Medicaid