Provider Demographics
NPI:1275632739
Name:MOORMAN, HAYDON A (MD MHSA)
Entity type:Individual
Prefix:
First Name:HAYDON
Middle Name:A
Last Name:MOORMAN
Suffix:
Gender:M
Credentials:MD MHSA
Other - Prefix:
Other - First Name:HAYDON
Other - Middle Name:ANTHONY
Other - Last Name:MOORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1736
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:
Practice Address - Street 1:2400 MOUNT ZION PARKWAY
Practice Address - Street 2:DEPARTMENT OF RHEUMATOLOGY
Practice Address - City:JONASBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-603-3828
Practice Address - Fax:770-603-3517
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054870207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
66BBBHGMedicare ID - Type Unspecified
A76904Medicare UPIN