Provider Demographics
NPI:1548328594
Name:HAGLER, NATHANIEL III (MD)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:HAGLER
Suffix:III
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 1:3340 PEACHTREE RD NE STE 2025
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1084
Mailing Address - Country:US
Mailing Address - Phone:404-946-9630
Mailing Address - Fax:
Practice Address - Street 1:333 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2657
Practice Address - Country:US
Practice Address - Phone:920-886-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA110995002085R0202X
WI38653-0202085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38653-020OtherWI LICENSE
WIA72715Medicare UPIN