MEDICARE: DR. ANISA LEE HAILEY DMD

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	1223G0001X	General Practice Dentistry	DN012026	GA

General Provider Information

NPI Number	:	1033310115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANISA LEE HAILEY DMD

Provider Business Mailing Address
First Line	:	4055 JOHNS CREEK PKWY
Second Line	:	SUITE B
City	:	SUWANEE
State	:	GA
Zip	:	30024-1299
Country	:	US
Telephone Number	:	678-436-1300
Fax Number	:	678-436-1303

Provider Business Practice Location Address
First Line	:	4055 JOHNS CREEK PKWY
Second Line	:	SUITE B
City	:	SUWANEE
State	:	GA
Zip	:	30024-1299
Country	:	US
Telephone Number	:	678-436-1300
Fax Number	:	678-436-1303

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	12/31/2008

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