Provider Demographics
NPI:1902111016
Name:HAUNSON, GREGORY TREY (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:TREY
Last Name:HAUNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 JOHNSON FERRY RD. NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-257-9933
Mailing Address - Fax:404-257-9931
Practice Address - Street 1:148 BILL CARRUTH PKWY.
Practice Address - Street 2:SUITE 280
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:678-363-3343
Practice Address - Fax:678-363-3380
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO2453208D00000X
GA71253207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice