Individual
HALEY THAXTON GAINOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1265 HIGHWAY 54 W, SUITE 102, FAYETTEVILLE, GA 30214-4548
(771) 460-1900
(770) 719-1214
Mailing address
900 CIRCLE 75 PKWY SE, SUITE 1700, ATLANTA, GA 30339-3035
(770) 953-6929
(770) 953-6972
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004816
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026138165A
—
GA
01
—
P00888417
RR MEDICARE
GA
Enumeration date
07/25/2006
Last updated
06/03/2014
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