Healthcare Provider Details

I. General information

NPI: 1831809128
Provider Name (Legal Business Name): HAYDEN ELIZABETH GILLEY AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

1170 N HIGHLAND AVE NE APT A14
ATLANTA GA
30306-3476
US

V. Phone/Fax

Practice location:
  • Phone: 334-790-7330
  • Fax:
Mailing address:
  • Phone: 334-790-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN284716
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN284716
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: