Healthcare Provider Details

I. General information

NPI: 1386435444
Provider Name (Legal Business Name): HALEY ZAGORIA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 CLAIREMONT AVE
DECATUR GA
30030-1207
US

IV. Provider business mailing address

195 ARIZONA AVE NE UNIT 148
ATLANTA GA
30307-2242
US

V. Phone/Fax

Practice location:
  • Phone: 404-314-0663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW011170
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: