Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS0000007272 | TN |
NPI | 1619968211 |
---|---|
Provider Name | Ms. Suzanne Watson Hayes |
First Address | Cookeville, TN 38501-0924 |
Second Address | Spencer, TN 38585-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 01/02/2021 |