=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801078035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONNA M. HANEY M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 08/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16125 BARNESVILLE STREET
-----------------------------------------------------
City | ZEBULON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-567-9593
-----------------------------------------------------
Fax | 770-567-8192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16125 BARNESVILLE STREET
-----------------------------------------------------
City | ZEBULON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30295-3598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-567-9593
-----------------------------------------------------
Fax | 770-567-8192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | DR. DONNA MICHELLE HANEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 770-567-9593
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 048638
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------