Provider Demographics
NPI:1700619475
Name:HAYNES, NANELLA ELIZABETH
Entity type:Individual
Prefix:
First Name:NANELLA
Middle Name:ELIZABETH
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 STARR RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2827
Mailing Address - Country:US
Mailing Address - Phone:470-944-0350
Mailing Address - Fax:
Practice Address - Street 1:2738 STARR RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2827
Practice Address - Country:US
Practice Address - Phone:470-944-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula