Provider Demographics
NPI:1578210530
Name:HADDOX, ABIGAIL TATYANNA
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:TATYANNA
Last Name:HADDOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7056 EGYPT PIKE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9078
Mailing Address - Country:US
Mailing Address - Phone:740-701-0249
Mailing Address - Fax:
Practice Address - Street 1:7056 EGYPT PIKE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9078
Practice Address - Country:US
Practice Address - Phone:740-701-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH73204125Medicaid