NPIMap

Organization Active NPI

Hailey, Brody, Casey & Wray, M.D., P.C.

  • Specialist
  • Atlanta, GA
National Provider Identifier
1184831364
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
HAILEY, BRODY, CASEY & WRAY, M.D., P.C.
Practice address
1218 West Paces Ferry Road
Suite 200
Atlanta, GA 30327-2306
Phone
(404) 525-7409
Fax
(404) 522-0608
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Miss Stacy Anne Brock
Title
Office Manager
Phone
(404) 525-7409

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X GA Primary

Addresses

Primary practice location

1218 West Paces Ferry Road
Suite 200
Atlanta, GA 30327-2306

Mailing address

1218 West Paces Ferry Road
Suite 200
Atlanta, GA 30327-2306
Phone (404) 525-7409

Other identifiers 1

IdentifierTypeStateIssuer
55000141AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040521000133 GA Part B Supplier - Clinic/Group Practice 0547251266 Receives reassigned benefits from 6 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

1218 W Paces Ferry Rd NW
Ste 200
Atlanta, GA 30327
Phone (404) 525-7409

550 Peachtree St NE
Ste 1135
Atlanta, GA 30308
Phone (404) 525-7409

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184831364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 WEST PACES FERRY ROAD",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303272306",
            "telephone_number": "404-525-7409",
            "fax_number": "404-522-0608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 WEST PACES FERRY ROAD",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303272306",
            "telephone_number": "404-525-7409",
            "fax_number": "404-522-0608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAILEY, BRODY, CASEY & WRAY, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "404-525-7409",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55000141A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.