Provider Demographics
NPI:1699420729
Name:COX, HALEY CLARKE (LD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:CLARKE
Last Name:COX
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-3102
Mailing Address - Country:US
Mailing Address - Phone:229-292-1945
Mailing Address - Fax:888-450-0379
Practice Address - Street 1:4808 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-3102
Practice Address - Country:US
Practice Address - Phone:229-292-1945
Practice Address - Fax:888-450-0379
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004390133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered