Provider Demographics
NPI:1770579864
Name:HAUCK, MAUREEN (AA)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:HAUCK
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4556 GRAYWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1026
Mailing Address - Country:US
Mailing Address - Phone:404-437-6880
Mailing Address - Fax:
Practice Address - Street 1:4575 N SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6445
Practice Address - Country:US
Practice Address - Phone:770-454-4065
Practice Address - Fax:770-454-4065
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAA-824207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ31749Medicare UPIN