Individual provider Active NPI

Justin Haskin

  • Family Nurse Practitioner
  • Valdosta, GA
National Provider Identifier
1194178327
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN224035 Issued in GA
Practice address
101F W Northside Dr
Valdosta, GA 31602-1700
Phone
(229) 262-1981
Fax
(229) 375-0392
NPI assigned
Jul 22, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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 RN224035 GA Primary

Addresses

Primary practice location

101F W Northside Dr
Valdosta, GA 31602-1700

Mailing address

101F W Northside Dr
Valdosta, GA 31602-1700
Phone (229) 262-1981

Other identifiers 1

IdentifierTypeStateIssuer
003184058CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160929001188 GA Practitioner - Nurse Practitioner 1951698273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Migraine and Spine Clinic of Valdosta LLCGroup PAC ID 3971881863, 2 clinicians

Practice addresses (Care Compare)

3315 N Valdosta Rd
Suite a
Valdosta, GA 31602-1107
Phone (229) 333-9838

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Migraine and Spine Clinic of Valdosta LLC CurrentSince Nov 7, 2016 Accepting new patients

Locations

3315 N Valdosta Rd
Ste A
Valdosta, GA 31602
Phone (229) 292-2074

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1194178327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101F W NORTHSIDE DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021700",
            "telephone_number": "229-262-1981",
            "fax_number": "229-375-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101F W NORTHSIDE DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021700",
            "telephone_number": "229-262-1981",
            "fax_number": "229-375-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASKIN",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-22",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN224035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003184058C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.