Provider Demographics
NPI:1023002730
Name:HAVILAND-FOLEY, DOLORES J (MD)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:J
Last Name:HAVILAND-FOLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E. 65TH STREET
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-3555
Practice Address - Street 1:101 ST. JOSEPH'S CANDLER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322
Practice Address - Country:US
Practice Address - Phone:912-748-1999
Practice Address - Fax:912-748-3847
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046860207Q00000X
GA46860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08CBCNDOtherMEDICARE
GA200480198DMedicaid