Provider Demographics
NPI:1568220457
Name:HALEY, IVRIYON (RDN)
Entity Type:Individual
Prefix:MS
First Name:IVRIYON
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 BON AIR DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3239
Mailing Address - Country:US
Mailing Address - Phone:504-473-1687
Mailing Address - Fax:
Practice Address - Street 1:1505 BON AIR DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3239
Practice Address - Country:US
Practice Address - Phone:504-473-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered