Healthcare Provider Details

I. General information

NPI: 1902824204
Provider Name (Legal Business Name): GREGORY ALAN HALEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/06/2013
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
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:
Title or Position:
Credential:
Phone: