Look up the most recent NPI and PECOS records

Nathan Grant Haverstick

Internal Medicine

Allopathic & Osteopathic Physicians

Community Internal Medicine Of Athens, 1500 Oglethorpe Ave Suite 200d, Athens, GA 30606

PECOS Enrollment

This provider is enrolled in PECOS as NATHAN HAVERSTICK.

Based on the most recent information from CMS, provider Nathan Grant Haverstick is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1023694890
Provider Type
Individual
Full Name
Haverstick, Nathan Grant
Title
Dr.
Credential
DO

Gender
Male
Sole Proprietor
No
Enumeration Date
3/22/2021
Last Updated
8/5/2022

Contact Information

Practice Location

Community Internal Medicine Of Athens, 1500 Oglethorpe Ave Suite 200d, Athens, GA 30606

(706) 389-3875

(706) 389-3876

Mailing Location

1230 Baxter Street, St. Mary'S Health Care System, Inc. Graduate Medical Ed, Athens, GA 30606-3712

(706) 389-3860

(706) 389-3861

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 13703 Georgia
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 13703	Description Other	Issuer GEORGIA COMPOSITE MEDICAL BOARD Georgia

Nathan Grant Haverstick

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Okoye, Cynthia Chizoba

Taylor, Brandon J

Nelson, Michael E

Brooks, Albert Patrick

Rodriguez, Nathaniel

Cook, Meghan B

Adelore, Tejumade

Ward, Lela Anne Laseter

Watson, Stephanie Nguyen

Johnson, Elizabeth L