Basic Information
| Provider Information | |||||||||
| NPI: | 1255420592 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HADLEY | ||||||||
| FirstName: | JOHNATHAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342696337 | ||||||||
| FaxNumber: | 3348340657 | ||||||||
| Practice Location | |||||||||
| Address1: | MARTIN ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | DEPARTMENT OF RADIOLOGY | ||||||||
| City: | FT. BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065443429 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 10/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 057813 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD28654 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.