MEDICARE: JAMES PATRICK HALEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	036769	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043250269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES PATRICK HALEY M.D.

Provider Business Mailing Address
First Line	:	227 RIVERSTONE DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-5256
Country	:	US
Telephone Number	:	770-720-7733
Fax Number	:	678-493-9875

Provider Business Practice Location Address
First Line	:	100 STONEFOREST DR
Second Line	:	SUITE 200
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-4880
Country	:	US
Telephone Number	:	770-720-7733
Fax Number	:	678-493-9875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	01/05/2015

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