Provider Demographics
NPI:1790713550
Name:HAIBACH, PATRICIA M (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:HAIBACH
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX V
Mailing Address - Street 2:601 SOUTH EIGHTH STREET
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0047
Mailing Address - Country:US
Mailing Address - Phone:770-467-6310
Mailing Address - Fax:678-990-7236
Practice Address - Street 1:601 SOUTH EIGHT STREET - HOSPITAL MEDICINE DEPARTMENT
Practice Address - Street 2:SPALDING REGIONAL MEDICAL CENTER
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-467-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057370207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI60448Medicare UPIN