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General NPI Number Information
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NPI Number | 1144433681
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Entity Type | Individual
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Provider Name | TARESSA GILLIG HANEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 400 PARK ST
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City | BELMONT
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State | NC
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Zip | 28012-3368
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Country | US
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Telephone | 704-295-3700
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Fax | 704-838-8494
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Provider Business Mailing Address
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Address Line | 6035 FAIRVIEW RD
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City | CHARLOTTE
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State | NC
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Zip | 28210-3256
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Country | US
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Telephone | 704-295-3000
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Fax | 704-838-8494
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2008-00936
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01059626A
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License Number State | IN
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