Basic Information
| Provider Information | |||||||||
| NPI: | 1790028736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HACKNEY | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 903 S RUFFNER RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253141646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043899096 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER DR. | ||||||||
| Address2: | ROOM 1144 | ||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265066201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042932463 | ||||||||
| FaxNumber: | 3042935160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 03/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | WV | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.