Provider Demographics
NPI:1831375468
Name:SCOUTEN, HALEY BARROW (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:BARROW
Last Name:SCOUTEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 LANCASTER WALK NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4860
Mailing Address - Country:US
Mailing Address - Phone:404-825-3849
Mailing Address - Fax:
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:678-819-0357
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA541705141JMedicaid
GA541705141LMedicaid
GA541705141KMedicaid
GA541705141JMedicaid