Active NPI
Jack Haney, PH.D.
- Clinical Child & Adolescent Psychologist
- Royston, GA
National Provider Identifier
1750309944
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jun 20, 2011.
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 1193
- Practice address
- 200 Bond St
Ste 122
Royston, GA 30662-4137 - Phone
- (706) 246-0900
- Fax
- (706) 246-0900
- NPI assigned
- Jul 17, 2006
- Last updated
- Sep 11, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1193 | GA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1193 | GA | Primary |
Addresses
Primary practice location
200 Bond St
Ste 122
Royston, GA 30662-4137
Mailing address
248 Tanglewood S
Royston, GA 30662-8244
Phone (706) 245-9516
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1193 | GA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1750309944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 TANGLEWOOD S",
"city": "ROYSTON",
"state": "GA",
"postal_code": "306628244",
"telephone_number": "706-245-9516",
"fax_number": "706-246-0900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 BOND ST",
"address_2": "STE 122",
"city": "ROYSTON",
"state": "GA",
"postal_code": "306624137",
"telephone_number": "706-246-0900",
"fax_number": "706-246-0900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANEY",
"first_name": "JACK",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "1193",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "GA",
"license": "1193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royston, GA
- Franklin County Health & Rehabilitation, LLC (Brown Health and Rehabilitation)
- Jade Freeman, PT, DPT
- Georgia Mountains Community Services (Avita Community Partners)
- Global Wound Care
- Halle Greer, OTRL
- David Michael Harris, MD
- Daniel Harrison, LPC
- Marcus Hegger, D.C.
- Marie Roberts Hendrix, M.ED., CCC-SLP
- Anne Fowler Hightower, PT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.