MEDICARE: ATRIUM OBGYN

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	174400000X	Specialist		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1035	OTHER	NC	ALVAREZ NC LICENSE#
2	1104	OTHER	NC	ZIMMERMAN NC LICENSE#
3	40022	OTHER	NC	JB NC LICENSE#
4	28040	OTHER	NC	HENDERSON NC LICENSE#
5	22477	OTHER	NC	HAAKENSON NC LICENSE#
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932108024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATRIUM OBGYN

Provider Business Mailing Address
First Line	:	2417 ATRIUM DR
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27607-6673
Country	:	US
Telephone Number	:	919-781-9555
Fax Number	:	919-781-1070

Provider Business Practice Location Address
First Line	:	2417 ATRIUM DR
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27607-6673
Country	:	US
Telephone Number	:	919-781-9555
Fax Number	:	919-781-1070

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY ALVIN HAAKENSON
Credential	:	MD
Telephone Number	:	919-781-9555

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/22/2020

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1265416036 — DIGESTIVE HEALTHCARE, PA
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Directions to “ATRIUM OBGYN ” Practice Location

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