Provider Demographics
NPI:1073534467
Name:HANEY, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:HANEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 E PINETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4807
Mailing Address - Country:US
Mailing Address - Phone:229-226-6000
Mailing Address - Fax:229-226-5859
Practice Address - Street 1:2282 E PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4807
Practice Address - Country:US
Practice Address - Phone:229-226-6000
Practice Address - Fax:229-226-5859
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000199713DMedicaid
GA000199713GMedicaid
GA58178OtherBLUE CROSS
GA000199713AMedicaid
180024651OtherRAILROAD MEDICARE
GA207500OtherWELLCARE
AL24988OtherBLUE CROSS
GA000199713AOtherAVESIS
GA000199713AOtherOPTICARE
FL068299300Medicaid
FL24988OtherBLUE CROSS
GA000199713AOtherPEACH STATE
GA000199713DMedicaid
GA18BDFKMMedicare PIN