Provider Demographics
NPI:1720216955
Name:HADLEY, DEGAIL JAMAR (DO)
Entity Type:Individual
Prefix:DR
First Name:DEGAIL
Middle Name:JAMAR
Last Name:HADLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E SUNFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2726
Mailing Address - Country:US
Mailing Address - Phone:662-441-2309
Mailing Address - Fax:662-545-4320
Practice Address - Street 1:700 E SUNFLOWER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2726
Practice Address - Country:US
Practice Address - Phone:662-441-2309
Practice Address - Fax:662-545-4320
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3510207Q00000X
MI5101018229207Q00000X
MS22227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty