Provider Demographics
NPI:1770578155
Name:HAVER, PAUL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:HAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2205 BARNETT SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3605
Mailing Address - Country:US
Mailing Address - Phone:706-548-1555
Mailing Address - Fax:706-548-1577
Practice Address - Street 1:2205 BARNETT SHOALS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3605
Practice Address - Country:US
Practice Address - Phone:706-548-1555
Practice Address - Fax:706-548-1577
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000475329AMedicaid
GA202I084711Medicare PIN
GAD18359Medicare UPIN
GA11BDNGXMedicare PIN