Healthcare Provider Details

I. General information

NPI: 1124801188
Provider Name (Legal Business Name): BRENDA CAROL HAILEY APC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CLAIREMONT AVE STE 400
DECATUR GA
30030-2546
US

IV. Provider business mailing address

160 CLAIREMONT AVE STE 400
DECATUR GA
30030-2546
US

V. Phone/Fax

Practice location:
  • Phone: 404-500-4266
  • Fax: 404-500-4283
Mailing address:
  • Phone: 404-500-4266
  • Fax: 404-500-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC009747
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: