Provider Demographics
NPI:1497193494
Name:HALEY, AUTUMN JEAN (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:JEAN
Last Name:HALEY
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:MISS
Other - First Name:AUTUMN
Other - Middle Name:JEAN
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DENTAL ASSISTANT
Mailing Address - Street 1:150 AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315-1780
Mailing Address - Country:US
Mailing Address - Phone:970-310-4629
Mailing Address - Fax:
Practice Address - Street 1:150 AMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315-1780
Practice Address - Country:US
Practice Address - Phone:970-310-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant