Healthcare Provider Details

I. General information

NPI: 1073443933
Provider Name (Legal Business Name): HALEY HARBUCK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 MANCHESTER EXPY
COLUMBUS GA
31904-6878
US

IV. Provider business mailing address

3674 GA HIGHWAY 240 N
MAUK GA
31058-3033
US

V. Phone/Fax

Practice location:
  • Phone: 706-596-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN294761
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: