Provider Demographics
NPI:1750483970
Name:HALEY, MAUREEN ANN (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:HALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 COLGAN CT SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2950
Mailing Address - Country:US
Mailing Address - Phone:404-405-3054
Mailing Address - Fax:
Practice Address - Street 1:2674 COLGAN CT SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2950
Practice Address - Country:US
Practice Address - Phone:404-405-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40395208600000X
WV18634208600000X
MN39565208600000X
AK4648208600000X
GA42594208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery