=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366176430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J. HADLEY MD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2022
-----------------------------------------------------
Last Update Date | 07/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 INVERNESS PLZ # 312
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-994-7026
-----------------------------------------------------
Fax | 903-209-2980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 INVERNESS PLZ # 312
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-994-7026
-----------------------------------------------------
Fax | 903-209-2980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JENNIFER HADLEY
-----------------------------------------------------
Credential | MD, PHD
-----------------------------------------------------
Telephone | 205-994-7016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------