Provider Demographics
NPI:1275635427
Name:HAITHCOCK, DANIEL B (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:HAITHCOCK
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 1:3330 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2559
Mailing Address - Country:US
Mailing Address - Phone:478-309-1809
Mailing Address - Fax:478-272-3589
Practice Address - Street 1:3330 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2559
Practice Address - Country:US
Practice Address - Phone:478-309-1809
Practice Address - Fax:478-272-3589
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400346207RC0000X
GA061887207RC0000X
ZZ061887207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA931451901AMedicaid
BH8048236OtherDEA
GA931451901AMedicaid