Provider Demographics
NPI:1497558795
Name:MARK L HAGOOD MD LLC
Entity type:Organization
Organization Name:MARK L HAGOOD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:HAGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-693-6863
Mailing Address - Street 1:239 S GREEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9012
Mailing Address - Country:US
Mailing Address - Phone:256-509-5547
Mailing Address - Fax:
Practice Address - Street 1:5768 HIGHWAY 431 S
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:AL
Practice Address - Zip Code:35741-9775
Practice Address - Country:US
Practice Address - Phone:256-693-6863
Practice Address - Fax:800-506-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty