Healthcare Provider Details

I. General information

NPI: 1154558468
Provider Name (Legal Business Name): HAILEY A AMICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 CLIFTON RD NE
ATLANTA GA
30322-4005
US

IV. Provider business mailing address

408 DREXEL AVE
DECATUR GA
30030-2808
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3903
  • Fax:
Mailing address:
  • Phone: 864-905-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number49899
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL31786
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: