Provider Demographics
NPI:1790193829
Name:HADLEY, DAKOTA L (PA-C)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:L
Last Name:HADLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9300 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9334
Mailing Address - Country:US
Mailing Address - Phone:843-764-1730
Mailing Address - Fax:843-764-1731
Practice Address - Street 1:9300 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9334
Practice Address - Country:US
Practice Address - Phone:843-764-1730
Practice Address - Fax:843-764-1731
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110004667363A00000X
SC2372363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant