Individual provider Active NPI

Glynnis J Haley, NP-C

  • Family Nurse Practitioner
  • Macon, GA
National Provider Identifier
1063585248
Registry record updated Jul 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN115633 Issued in GA
Practice address
250 Martin Luther King Jr Blvd
Macon, GA 31201
Phone
(478) 301-4111
Fax
(478) 301-5812
NPI assigned
Nov 16, 2006
Last updated
Jul 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN115633 GA Primary

Addresses

Primary practice location

250 Martin Luther King Jr Blvd
Macon, GA 31201

Mailing address

PO Box 4947
Macon, GA 31208-4947
Phone (478) 301-2362

Other identifiers 2

IdentifierTypeStateIssuer
000934304CMedicaidGA
500025995OtherGARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Cancer Specialists I, PC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405555200000",
    "number": "1063585248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4947",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312084947",
            "telephone_number": "478-301-2362",
            "fax_number": "478-301-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MARTIN LUTHER KING JR BLVD",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31201",
            "telephone_number": "478-301-4111",
            "fax_number": "478-301-5812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALEY",
        "first_name": "GLYNNIS",
        "middle_name": "J",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2014-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN115633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000934304C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "500025995",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.