Healthcare Provider Details

I. General information

NPI: 1598794109
Provider Name (Legal Business Name): WILLIAM KENDRIC HALEY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEDICAL DR 4TH FLOOR
ELBERTON GA
30635-1830
US

IV. Provider business mailing address

4 MEDICAL DR 4TH FLOOR
ELBERTON GA
30635-1830
US

V. Phone/Fax

Practice location:
  • Phone: 706-213-6618
  • Fax: 706-283-6124
Mailing address:
  • Phone: 706-213-6618
  • Fax: 706-283-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number031754
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: