Provider Demographics
NPI:1548299829
Name:HAYMAN, KENNETH H JR (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:HAYMAN
Suffix:JR
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:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:941 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3909
Practice Address - Country:US
Practice Address - Phone:423-894-7870
Practice Address - Fax:865-539-8008
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15156207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3145762OtherBCBS OF TENNESSEE
TN3327041Medicaid
TNP00192338OtherRAILROAD MEDICARE
TN3009342Medicaid
TN0127043OtherBLUE CROSS
TN3009342Medicare PIN
TN3327041Medicaid
TN3009342Medicaid