Healthcare Provider Details

I. General information

NPI: 1730330705
Provider Name (Legal Business Name): GREGORY A. HALEY MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N DECATUR RD
SCOTTDALE GA
30079-1143
US

IV. Provider business mailing address

3033 N DECATUR RD P.O. BOX 102
SCOTTDALE GA
30079-1143
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-9908
  • Fax: 404-508-9906
Mailing address:
  • Phone: 404-508-9908
  • Fax: 404-508-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number43636
License Number StateGA

VIII. Authorized Official

Name: MR. FELIX KUEMMERLI
Title or Position: OFFICE MANAGER
Credential:
Phone: 404-508-9908