Healthcare Provider Details

I. General information

NPI: 1548328594
Provider Name (Legal Business Name): NATHANIEL HAGLER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N COMMERCIAL ST
NEENAH WI
54956-2657
US

IV. Provider business mailing address

3340 PEACHTREE RD NE STE 2025
ATLANTA GA
30326-1084
US

V. Phone/Fax

Practice location:
  • Phone: 920-886-7525
  • Fax:
Mailing address:
  • Phone: 404-946-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number38653-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA11099500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: