Provider Demographics
NPI:1598787012
Name:HADLEY, ISAAC S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:S
Last Name:HADLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NORTH OAKLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906
Mailing Address - Country:US
Mailing Address - Phone:706-689-2905
Mailing Address - Fax:
Practice Address - Street 1:131 N OAKLEY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-4476
Practice Address - Country:US
Practice Address - Phone:706-689-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00132976AMedicaid
GA100178OtherAVESIS DENTAL
GA9179510OtherDORAL DENTAL SERVICES