Healthcare Provider Details

I. General information

NPI: 1790413037
Provider Name (Legal Business Name): HAYLEE ANN HUBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 JOHNSON FERRY PL STE G10
MARIETTA GA
30068-2045
US

IV. Provider business mailing address

786 MARTINA DR NE
ATLANTA GA
30305-2774
US

V. Phone/Fax

Practice location:
  • Phone: 770-321-6705
  • Fax:
Mailing address:
  • Phone: 972-365-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: