MEDICARE: DR. MATTHEW RYAN HAACK M.D.

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	207R00000X	Internal Medicine Physician	5643	NE
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	070192	GA
3	207RP1001X	Pulmonary Disease Physician	070192	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1811186828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW RYAN HAACK M.D.

Provider Business Mailing Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE 130
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8017
Country	:	US
Telephone Number	:	678-493-2527
Fax Number	:	678-493-5608

Provider Business Practice Location Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE 130
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8017
Country	:	US
Telephone Number	:	678-493-2527
Fax Number	:	678-493-5608

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

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	04/26/2021

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Directions to “ DR. MATTHEW RYAN HAACK M.D.” Practice Location

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