Healthcare Provider Details

I. General information

NPI: 1255084430
Provider Name (Legal Business Name): HALEY MCGAHA RDN, CSO, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD STE D250
ATLANTA GA
30342-1646
US

IV. Provider business mailing address

993 JOHNSON FERRY RD STE D250
ATLANTA GA
30342-1646
US

V. Phone/Fax

Practice location:
  • Phone: 404-236-8036
  • Fax:
Mailing address:
  • Phone: 404-236-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: