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NPI Code Detail

MEDICARE: HAILEY HANDERHAN PA-C

MEDICARE: HAILEY HANDERHAN PA-C
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
1363A00000XPhysician Assistant12016GA
2363AS0400XSurgical Physician Assistant12016GA
3363AM0700XMedical Physician Assistant12016GA
4390200000XStudent in an Organized Health Care Education/Training Program

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679284798
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEY HANDERHAN PA-C
Provider Business Mailing Address
First Line : PO BOX 742616
Second Line :
City : ATLANTA
State : GA
Zip : 30374-2616
Country : US
Telephone Number : 770-219-9000
Fax Number :
Provider Business Practice Location Address
First Line : 743 SPRING ST NE
Second Line :
City : GAINESVILLE
State : GA
Zip : 30501-3715
Country : US
Telephone Number : 770-219-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2022
Last Update Date : 03/02/2026

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Directions to “ HAILEY HANDERHAN PA-C” Practice Location

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