Healthcare Provider Details

I. General information

NPI: 1801078035
Provider Name (Legal Business Name): DONNA M. HANEY M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16125 BARNESVILLE STREET
ZEBULON GA
30295
US

IV. Provider business mailing address

16125 BARNESVILLE STREET
ZEBULON GA
30295-3598
US

V. Phone/Fax

Practice location:
  • Phone: 770-567-9593
  • Fax: 770-567-8192
Mailing address:
  • Phone: 770-567-9593
  • Fax: 770-567-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number048638
License Number StateGA

VIII. Authorized Official

Name: DR. DONNA MICHELLE HANEY
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 770-567-9593