1760757793 NPI number — MS. DONNA LOUISE BAYNES LPC

Table of content: GONZALO PEREZ HELGUERO (NPI 1467313130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760757793 NPI number — MS. DONNA LOUISE BAYNES LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAYNES
Provider First Name:
DONNA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAYNES
Provider Other First Name:
DONNA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760757793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 N CREEK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30238-5635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-361-3454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 HABERSHAM DR
Provider Second Line Business Practice Location Address:
113
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214-1381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-361-3454
Provider Business Practice Location Address Fax Number:
770-371-5002
Provider Enumeration Date:
03/08/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  02818 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)