Healthcare Provider Details

I. General information

NPI: 1184917841
Provider Name (Legal Business Name): EMILY ELIZABETH HADLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S MAIN ST
FORT WORTH TX
76104
US

IV. Provider business mailing address

1412 MAY ST
FORT WORTH TX
76104-7639
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-6500
  • Fax: 817-920-6559
Mailing address:
  • Phone: 817-702-2450
  • Fax: 817-702-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberQ4969
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberQ4969
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: