Provider Demographics
NPI:1336358332
Name:HADDAN, JAMIE BURLESON (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:BURLESON
Last Name:HADDAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BLUESEDGE LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6457
Mailing Address - Country:US
Mailing Address - Phone:770-667-5962
Mailing Address - Fax:
Practice Address - Street 1:9925 HAYNES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8532
Practice Address - Country:US
Practice Address - Phone:770-751-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023480183500000X
AL15442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist