Keianna S Haley, CNM

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

RN273633 Issued in GA

Practice address

10692 Medlock Bridge Rd Ste 100
Johns Creek, GA 30097-8497

Phone

(404) 446-2497

NPI assigned

Feb 15, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Certified Nurse Midwife (CNM)

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: keianna.haley@durronobgyn.gadirect.net

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Dourron Northside OB GYN LLC

  • Obstetrics & Gynecology Physician
  • Decatur, GA
  • NPI 1427563584

  Single Specialty

  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240

  Single Specialty

  NPD
• Wellstar Medical Group, LLC

  • Allergy & Immunology Physician
  • Smyrna, GA
  • NPI 1538467303

  Single Specialty

  NPD

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

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1831699966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6055 COURTSIDE DR",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300922361",
            "telephone_number": "347-731-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10692 MEDLOCK BRIDGE RD STE 100",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300978497",
            "telephone_number": "404-446-2497"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3240 Avalon Blvd",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300136320",
            "country_code": "US",
            "telephone_number": "770-860-1133",
            "fax_number": "770-860-1599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALEY",
        "first_name": "KEIANNA",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-15",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "GA",
            "license": "CNM04739",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "RN273633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003201850",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kellie Gwaltney, MA, LMFT, LPC
• H&B Family Dental, LLC
• Sunyoung Ha
• Nicole Cristina Habibe Burgos, MD
• Mohammad Hajiha, MD, FRCSC UROLOGY
• Tonya Michelle Haley, DPT
• Stephanie Leigh Hall, DVM
• Dylan S Hamilton, D.M.D.
• Victoria Hamilton
• Kimberly Hammett

• Obstetrics & Gynecology Physician in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.