Provider Demographics
NPI:1730102245
Name:HAUSER, JONATHAN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:HAUSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DEVANT STREET STE 705
Mailing Address - Street 2:CARNEGIE BEHAVIORAL HEALTH
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2717
Mailing Address - Country:US
Mailing Address - Phone:770-716-6012
Mailing Address - Fax:770-716-6013
Practice Address - Street 1:101 DEVANT STREET STE 705
Practice Address - Street 2:CARNEGIE BEHAVIORAL HEALTH
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2717
Practice Address - Country:US
Practice Address - Phone:770-716-6012
Practice Address - Fax:770-716-6013
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002374103TC0700X
GAGA002374103TC0700X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000857095BMedicaid
GA000857095BMedicaid
GA68BBGDMMedicare PIN