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General NPI Number Information
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NPI Number | 1447258215
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Entity Type | Individual
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Provider Name | JESSE CORNELIUS HAGGERTY III MD, MSC, MPH, PHD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 515 STATE DOCKS RD
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City | EUFAULA
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State | AL
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Zip | 36027-3354
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Country | US
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Telephone | 334-687-0250
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Fax | 334-687-0299
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Provider Business Mailing Address
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Address Line | 515 STATE DOCKS RD
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City | EUFAULA
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State | AL
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Zip | 36027-3354
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Country | US
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Telephone | 334-687-0250
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Fax | 334-687-0299
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 049855
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 01D0985382
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24003
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License Number State | AL
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