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General NPI Number Information
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NPI Number | 1609857291
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Entity Type | Individual
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Provider Name | KENNON H HAGER MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 820 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5223
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Country | US
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Telephone | 251-460-0326
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Fax | 251-460-2846
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Provider Business Mailing Address
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Address Line | 820 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5223
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Country | US
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Telephone | 256-549-0008
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Fax | 256-549-0401
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 17729
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License Number State | AL
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