Provider Demographics
NPI:1629755061
Name:FAITH, HAYDEN
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:FAITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 MULBERRY CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2291
Mailing Address - Country:US
Mailing Address - Phone:770-500-9314
Mailing Address - Fax:
Practice Address - Street 1:199 MULBERRY CT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2291
Practice Address - Country:US
Practice Address - Phone:770-500-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2024-05-01
Deactivation Date:2024-04-05
Deactivation Code:
Reactivation Date:2024-05-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program