1629487855 NPI number — MRS. PATRICIA A HASELDEN APRN, BC

Table of content: MRS. PATRICIA A HASELDEN APRN, BC (NPI 1629487855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629487855 NPI number — MRS. PATRICIA A HASELDEN APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASELDEN
Provider First Name:
PATRICIA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALY
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629487855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 116336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-6336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-629-7800
Provider Business Mailing Address Fax Number:
912-355-5515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4750 WATERS AVE
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-629-7800
Provider Business Practice Location Address Fax Number:
912-355-5515
Provider Enumeration Date:
08/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  RN076917 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003183193J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003183193K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003183193A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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