Basic Information
Provider Information
NPI: 1598284739
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MABREY
FirstName: HALEY
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 503 CLARK ST NE
Address2:  
City: CULLMAN
State: AL
PostalCode: 350551921
CountryCode: US
TelephoneNumber: 2567390801
FaxNumber: 2567390027
Practice Location
Address1: 408 CLARK ST NE
Address2:  
City: CULLMAN
State: AL
PostalCode: 350551953
CountryCode: US
TelephoneNumber: 2567390801
FaxNumber: 2567390027
Other Information
ProviderEnumerationDate: 09/19/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD.39149ALY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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