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General NPI Number Information
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NPI Number | 1932108024
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Entity Type | Organization
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Legal Business Name | ATRIUM OBGYN
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2417 ATRIUM DR SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27607-6673
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Country | US
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Telephone | 919-781-9555
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Fax | 919-781-1070
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Provider Business Mailing Address
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Address Line | 2417 ATRIUM DR SUITE 200
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City | RALEIGH
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State | NC
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Zip | 27607-6673
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Country | US
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Telephone | 919-781-9555
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Fax | 919-781-1070
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY ALVIN HAAKENSON
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Credential | MD
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Telephone | 919-781-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NC
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