Individual
MS. HALEY C GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1968 PEACHTREE ROAD NW, ATLANTA, GA 30309-1281
(404) 351-1745
(404) 351-7121
Mailing address
1087 MCLYNN AVE NE, ATLANTA, GA 30306-3324
(404) 313-5833
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN165923
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN165923
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
864081803B
—
GA
Enumeration date
07/09/2009
Last updated
03/11/2020
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