Healthcare Provider Details

I. General information

NPI: 1114575487
Provider Name (Legal Business Name): MARGAUX HALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAMMOND DR STE 100
ATLANTA GA
30328-5532
US

IV. Provider business mailing address

4600 ROSWELL RD UNIT 693
ATLANTA GA
30342-3096
US

V. Phone/Fax

Practice location:
  • Phone: 877-288-4760
  • Fax:
Mailing address:
  • Phone: 404-889-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-40175
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: