Provider Demographics
NPI:1538192539
Name:HAYMON, SANDRA WAUTHENA (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:WAUTHENA
Last Name:HAYMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 US HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-0510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 OLD ALBANY RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4014
Practice Address - Country:US
Practice Address - Phone:229-228-8100
Practice Address - Fax:229-228-8154
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY005273103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00822214AMedicaid
GA00822214AMedicaid
GAS33716Medicare UPIN