Provider Demographics
NPI:1528849429
Name:HAYES, JOHNNY CARTER
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:CARTER
Last Name:HAYES
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 1:193 FARMINGDON DR
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-6896
Mailing Address - Country:US
Mailing Address - Phone:229-539-5105
Mailing Address - Fax:
Practice Address - Street 1:193 FARMINGDON DR
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-6896
Practice Address - Country:US
Practice Address - Phone:229-539-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01765101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)