Provider Demographics
NPI:1548859010
Name:FALEY, HALLIE JAYE
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:JAYE
Last Name:FALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BURNT HICKORY RD NW APT 936
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1374
Mailing Address - Country:US
Mailing Address - Phone:480-862-9108
Mailing Address - Fax:
Practice Address - Street 1:1001 BURNT HICKORY RD NW APT 936
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1374
Practice Address - Country:US
Practice Address - Phone:480-862-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GATEMP201610163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GATEMP201610OtherREGISTERED NURSE