Provider Demographics
NPI:1073515730
Name:HALEY, TIMOTHY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:HALEY
Suffix:
Gender:M
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0729
Mailing Address - Country:US
Mailing Address - Phone:334-793-2663
Mailing Address - Fax:334-836-2247
Practice Address - Street 1:1500 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4754
Practice Address - Country:US
Practice Address - Phone:334-793-2663
Practice Address - Fax:334-836-2247
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25857207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-08333OtherBCBS OF AL - HEALTHWEST
AL121882Medicaid
GA025598290AMedicaid
AL515-22051OtherBCBS OF AL 1500 RCC
GA025598290CMedicaid
AL009956455Medicaid
AL511-08333OtherBCBS OF AL - HEALTHWEST
GA025598290CMedicaid