Individual
GLYNNIS J HALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
250 MARTIN LUTHER KING JR BLVD, MACON, GA 31201
(478) 301-4111
(478) 301-5812
Mailing address
PO BOX 4947, MACON, GA 31208-4947
(478) 301-2362
(478) 301-2272
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN115633
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000934304C
—
GA
01
—
500025995
RAILROAD MEDICARE
GA
Enumeration date
11/16/2006
Last updated
07/17/2014
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