Provider Demographics
NPI:1710125745
Name:STRATTON, HALEH M (PA)
Entity Type:Individual
Prefix:
First Name:HALEH
Middle Name:M
Last Name:STRATTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4045 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1253
Mailing Address - Country:US
Mailing Address - Phone:770-495-7116
Mailing Address - Fax:770-495-9410
Practice Address - Street 1:4045 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1253
Practice Address - Country:US
Practice Address - Phone:770-495-7116
Practice Address - Fax:770-495-9410
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002617363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA931002007CMedicaid