MEDICARE: HALEY S LUSTIG RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN241464	GA

General Provider Information

NPI Number	:	1013875004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY S LUSTIG RN

Provider Business Mailing Address
First Line	:	450 WINDSOR PKWY
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2786
Country	:	US
Telephone Number	:	706-424-9568
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 WINDSOR PKWY
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2786
Country	:	US
Telephone Number	:	706-424-9568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2026
Last Update Date	:	01/10/2026

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