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General NPI Number Information
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NPI Number | 1780265843
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Entity Type | Individual
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Provider Name | GARRETT RYAN HADLEY DO
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Gender | Male
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 2302 COLLEGE AVE STE 100
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City | CONWAY
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State | AR
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Zip | 72034-6297
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Country | US
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Telephone | 501-513-5385
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Fax | 501-513-5257
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Provider Business Mailing Address
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Address Line | PO BOX 9662
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City | CONWAY
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State | AR
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Zip | 72033-9662
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Country | US
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Telephone | 501-852-1363
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Fax | 501-852-1364
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-18341
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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