Provider Demographics
NPI:1144433681
Name:HANEY, TARESSA GILLIG (MD)
Entity type:Individual
Prefix:DR
First Name:TARESSA
Middle Name:GILLIG
Last Name:HANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:400 PARK ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3368
Practice Address - Country:US
Practice Address - Phone:704-295-3700
Practice Address - Fax:704-838-8494
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00936207W00000X
IN01059626A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2687OtherEVOLUTIONS HEALTHCARE
SC01212093OtherAMERIGROUP COMMUNITY CARE
NC56162OtherMEDCOST
NC9457063OtherAETNA
NC150TAOtherBCBSNC
SC000000289876OtherUNISON HEALTH PLAN OF SC
SC20090727OtherSELECT HEALTH OF SC
SCN0093EMedicaid
NC5909916Medicaid
SC770893OtherWELLCARE
SC87882OtherCHCCARES OF SC
NCP01223901OtherMEDICARE-RAILROAD
SCN0093EMedicaid