Individual
HALEY THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1062 FORSYTH ST STE 1B, MACON, GA 31201-8638
(478) 741-1208
Mailing address
1062 FORSYTH ST STE 1B, MACON, GA 31201-8638
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN215969
GA
363L00000X
Nurse Practitioner
Primary
RN215969
GA
Other
Enumeration date
02/28/2020
Last updated
09/21/2021
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