Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | CHIR005426GA | GA |
NPI | 1326135765 |
---|---|
Provider Name | Dr. Robert Alan Hayden |
First Address | Griffin, GA 30224-4235 |
Second Address | Griffin, GA 30224-4235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U58580 | (02) | GA |