Provider Demographics
NPI:1194947143
Name:HALEY, HEATHER L (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:HALEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 FRANKLIN ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4310
Mailing Address - Country:US
Mailing Address - Phone:256-533-7676
Mailing Address - Fax:256-533-3171
Practice Address - Street 1:810 FRANKLIN ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4310
Practice Address - Country:US
Practice Address - Phone:256-533-7676
Practice Address - Fax:256-533-3171
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO943207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910519Medicaid
ALE683OtherMEDICARE GROUP
AL009910540Medicaid
AL051559243Medicare PIN