Provider Demographics
NPI:1316425846
Name:HAUN, ALAN COSMO (PA-C)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:COSMO
Last Name:HAUN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 THOMPSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-1813
Mailing Address - Country:US
Mailing Address - Phone:770-530-4480
Mailing Address - Fax:
Practice Address - Street 1:900 N HERITAGE DR
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5536
Practice Address - Country:US
Practice Address - Phone:760-446-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant