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General NPI Number Information
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NPI Number | 1124668231
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Entity Type | Individual
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Provider Name | SUSANNA LONG HALEY PA
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 2301 ROBESON ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5640
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Country | US
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Telephone | 910-484-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 905 EMELINE AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5421
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Country | US
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Telephone | 910-308-9843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-09668
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License Number State | NC
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