Provider Demographics
NPI:1598794109
Name:HALEY, WILLIAM KENDRIC (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KENDRIC
Last Name:HALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4 MEDICAL DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1830
Mailing Address - Country:US
Mailing Address - Phone:706-213-6618
Mailing Address - Fax:706-283-6124
Practice Address - Street 1:4 MEDICAL DR
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1830
Practice Address - Country:US
Practice Address - Phone:706-213-6618
Practice Address - Fax:706-283-6124
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA031754208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000387318CMedicaid
GAD51842Medicare UPIN
GA02BBCLXMedicare ID - Type Unspecified