Individual provider Active NPI

Haris Hatic, D.O.

  • Hematology & Oncology Physician
  • Lawrenceville, GA
National Provider Identifier
1407219041
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
91140 Issued in GA
Practice address
631 Professional Dr Ste 450
Lawrenceville, GA 30046-3370
Phone
(770) 963-8030
Fax
(770) 339-9577
NPI assigned
Mar 31, 2016
Last updated
Jun 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Hematology & Oncology Physician 207RH0003X 91140 GA Primary

Addresses

Primary practice location

631 Professional Dr Ste 450
Lawrenceville, GA 30046-3370

Mailing address

631 Professional Dr Ste 450
Lawrenceville, GA 30046-3370
Phone (770) 963-8030

Other practice location 1

665 Duluth Hwy Ste 401
Lawrenceville, GA 30046-4303
Phone (678) 312-0400

Other practice location 2

625 19th Street South
Birmingham, AL 35249-4303
Phone (205) 934-2721

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220614001593 GA Practitioner - Hematology/Oncology 6901199330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Edward Via Col of Osteo Medicine-Carolinas Campus, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Atlanta Oncology Services LLCGroup PAC ID 1850627423, 29 clinicians

Practice addresses (Care Compare)

631 Professional Dr
Suite 450
Lawrenceville, GA 30046-3370
Phone (770) 963-8030

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1963ALMDChiropractor
91140GAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Atlanta Oncology Services LLC CurrentSince Aug 1, 2022 Accepting new patients

Locations

2098 Teron Trce
Ste 400
Dacula, GA 30019
Phone (678) 312-6800

631 Professional Dr
Ste 450
Lawrenceville, GA 30046
Phone (770) 963-8030

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1407219041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DR STE 450",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463370",
            "telephone_number": "770-963-8030",
            "fax_number": "770-339-9577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DR STE 450",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463370",
            "telephone_number": "770-963-8030",
            "fax_number": "770-339-9577"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "665 Duluth Hwy Ste 401",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300464303",
            "country_code": "US",
            "telephone_number": "678-312-0400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "625 19th Street South",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352494303",
            "country_code": "US",
            "telephone_number": "205-934-2721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HATIC",
        "first_name": "HARIS",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-31",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "GA",
            "license": "91140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.