Provider Demographics
NPI:1588755482
Name:BROOKS, HAIDY M (PA-C)
Entity type:Individual
Prefix:
First Name:HAIDY
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
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 1:55 WHITCHER STREET
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1129
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-424-9095
Practice Address - Street 1:5885 GLENRIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5572
Practice Address - Country:US
Practice Address - Phone:188-890-8055
Practice Address - Fax:720-598-0440
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA781124758FMedicaid
GA781124758DMedicaid
GA781124758CMedicaid
GA781124758BMedicaid
GA781124758EMedicaid
GA781124758EMedicaid