Provider Demographics
NPI:1902824204
Name:HALEY, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:HALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3033 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1143
Mailing Address - Country:US
Mailing Address - Phone:404-508-9908
Mailing Address - Fax:404-508-9906
Practice Address - Street 1:3033 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1143
Practice Address - Country:US
Practice Address - Phone:404-508-9908
Practice Address - Fax:404-508-9906
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA436362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7169Medicare ID - Type Unspecified