Individual
MRS. LOREN HAYNES KLEIMEYER HALBROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 TOWER RD NE STE 200, MARIETTA, GA 30060-9403
(770) 427-5717
(770) 425-4183
Mailing address
NORTHSIDE HOSPITAL- MANAGED CARE DEPT, 1000 JOHNSON FERRY RD, ATLANTA, GA 30342-1606
(404) 300-2476
(404) 250-8010
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
007089
GA
363AS0400X
Surgical Physician Assistant
Primary
007089
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I976484
PTAN
GA
Enumeration date
02/07/2014
Last updated
03/07/2019
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