Provider Demographics
NPI:1154787752
Name:O'REILLY, HALEY L (PA)
Entity type:Individual
Prefix:MS
First Name:HALEY
Middle Name:L
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:HALEY
Other - Middle Name:L
Other - Last Name:TOLVSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1841
Mailing Address - Country:US
Mailing Address - Phone:404-778-1900
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-2134
Practice Address - Country:US
Practice Address - Phone:404-778-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109164363A00000X
GA10318363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016570700Medicaid
FLPA9109164OtherMEDICAL LICENSE
FL016570700Medicaid