Glen H Havens, MD PC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

32748 Issued in GA

Practice address

11113 Houze Rd
Suite 100
Roswell, GA 30076

Phone

(770) 998-1516

Fax

(770) 998-1711

NPI assigned

Mar 7, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 9, 2019 through Oct 9, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871623819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11113 HOUZE RD",
            "address_2": "SUITE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30076",
            "telephone_number": "770-998-1516",
            "fax_number": "770-998-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11113 HOUZE RD",
            "address_2": "SUITE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30076",
            "telephone_number": "770-998-1516",
            "fax_number": "770-998-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVENS",
        "first_name": "GLEN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "32748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Chapman Hasan, CRNA
• Mohamad Hashem
• Morgan Hassel
• Madison Hathaway, RBT
• Haus of Harmony Psychiatry & Wellness Center
• Lana Jenae Hawkins, LPMT, MT-BC
• Natalie Hawkins
• Madelyn Hawwari
• Shannon M. Hay, PT, DPT
• Taylor Hay, BCBA

• Psychiatry Physician in Roswell, GA
• Providers in Roswell, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.