Provider Demographics
NPI:1790028736
Name:HACKNEY, ADAM MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MICHAEL
Last Name:HACKNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 S RUFFNER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1646
Mailing Address - Country:US
Mailing Address - Phone:304-389-9096
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR.
Practice Address - Street 2:ROOM 1144
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-6201
Practice Address - Country:US
Practice Address - Phone:304-293-2463
Practice Address - Fax:304-293-5160
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program