Hathaway, Gary S

Hathaway, Gary S is an individual health care provider with primary practice located at 590 Nancy St Nw , Marietta GA 30060-1334. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Hathaway, Gary S can be contacted via phone (770) 423-0395.

Contact Information

Primary practice address
590 Nancy St Nw Marietta GA 30060-1334
Phone: (770) 423-0395
Fax: (770) 499-0352
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 042599 Georgia

Profile Details

NPI number 1164489373
LBN Legal business name Hathaway, Gary S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 1st, 2006
Last updated Dec 3rd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164489373 NPPES
Georgia Other 52636051-004 BC/BS ID
Georgia Other 565113 BC/BS ID
Georgia Other 5647403 BC/BS ID
Georgia MEDICAID 00744961D BC/BS ID
Georgia Other 020042822 BC/BS ID

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