Healthcare Provider Details

I. General information

NPI: 1154941714
Provider Name (Legal Business Name): JOHN C HAIGHT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 RIVERSTONE TER STE 101
CANTON GA
30114-1703
US

IV. Provider business mailing address

132 RIVERSTONE TER STE 101
CANTON GA
30114-1703
US

V. Phone/Fax

Practice location:
  • Phone: 678-880-0036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001457
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number890
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: