MEDICARE: HALEIGH ANDERSON 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	163WP0200X	Pediatric Registered Nurse	RN266842	GA
2	363LP0200X	Pediatric Nurse Practitioner	APRN-NP266842	GA

General Provider Information

NPI Number	:	1487276770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEIGH ANDERSON RN

Provider Business Mailing Address
First Line	:	3883 CHAMBLEE DUNWOODY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1701
Country	:	US
Telephone Number	:	678-644-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	3883 CHAMBLEE DUNWOODY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1701
Country	:	US
Telephone Number	:	678-644-1230
Fax Number	:

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

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	02/12/2026

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