Provider Demographics
NPI:1104348929
Name:HAUSER, KRISTIN DAVIS (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DAVIS
Last Name:HAUSER
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 1:1488 JESSE JEWELL PKWY SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3804
Mailing Address - Country:US
Mailing Address - Phone:770-532-7179
Mailing Address - Fax:
Practice Address - Street 1:1488 JESSE JEWELL PKWY SE STE 100
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3804
Practice Address - Country:US
Practice Address - Phone:770-532-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA100002207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program