1679583132 NPI number — JOAN HADER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679583132 NPI number — JOAN HADER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HADER

Provider First Name:

JOAN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1679583132

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/31/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5673 PEACHTREE DUNWOODY RD NE

Provider Second Line Business Mailing Address:

STE 910

Provider Business Mailing Address City Name:

ATLANTA

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30342-1731

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

404-255-3822

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

5673 PEACHTREE DUNWOODY RD NE

Provider Second Line Business Practice Location Address:

STE 910

Provider Business Practice Location Address City Name:

ATLANTA

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30342-1731

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

404-255-3822

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208800000X , with the licence number:  036536 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: AH01 . This is a "ENVOY SITE ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 036536 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 4334942 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: P3660719 . This is a "OXFORD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 203543680 . This is a "MULTIPLAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 203543680 . This is a "AULTCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 904115 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 611747900 . This is a "US DEPT OF LABOR WC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: P00278109 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 203543680 . This is a "GHI PPO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 52550573 . This is a "BCBS Q CARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 611747900 . This is a "WORKERS COMP TX-FED EMPYS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".