Individual
MRS. KEIANNA S HALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
10692 MEDLOCK BRIDGE RD STE 100, JOHNS CREEK, GA 30097-8497
(404) 446-2497
Mailing address
6055 COURTSIDE DR, PEACHTREE CORNERS, GA 30092-2361
(347) 731-0787
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
RN273633
GA
207VX0201X
Gynecologic Oncology Physician
CNM04739
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003201850
—
GA
Enumeration date
02/15/2018
Last updated
02/17/2021
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