Healthcare Provider Details

I. General information

NPI: 1992281885
Provider Name (Legal Business Name): HALLY ANN WARKENTINE CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALLY ANN DAVIDSON CAA

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8000
  • Fax:
Mailing address:
  • Phone: 404-851-8917
  • Fax: 404-303-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number8907
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: