Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN211603 | GA |
NPI | 1003361064 |
---|---|
Provider Name | Rhonda Jeannean Haynes |
First Address | Albany, GA 31707-2983 |
Second Address | Albany, GA 31707-2983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2016 |
Last Update Date | 19/08/2016 |