Basic Information
| Provider Information | |||||||||
| NPI: | 1144433681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANEY | ||||||||
| FirstName: | TARESSA | ||||||||
| MiddleName: | GILLIG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PARK ST | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280123368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953700 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 2008-00936 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 01059626A | IN | N | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 2687 | 01 | NC | EVOLUTIONS HEALTHCARE | OTHER | 01212093 | 01 | SC | AMERIGROUP COMMUNITY CARE | OTHER | 56162 | 01 | NC | MEDCOST | OTHER | 9457063 | 01 | NC | AETNA | OTHER | 150TA | 01 | NC | BCBSNC | OTHER | 000000289876 | 01 | SC | UNISON HEALTH PLAN OF SC | OTHER | 20090727 | 01 | SC | SELECT HEALTH OF SC | OTHER | N0093E | 05 | SC | MEDICAID | 5909916 | 05 | NC | MEDICAID | 770893 | 01 | SC | WELLCARE | OTHER | 87882 | 01 | SC | CHCCARES OF SC | OTHER | P01223901 | 01 | NC | MEDICARE-RAILROAD | OTHER |