Hathcock, Samuel Gordon
Hathcock, Samuel Gordon is an sole proprietor health care provider with primary practice located at 410 Celebration Pl Ste 300 , Celebration FL 34747-5434. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Hathcock, Samuel Gordon can be contacted via phone (407) 894-4474.Contact Information
Primary practice address
410 Celebration Pl Ste 300
Celebration FL 34747-5434
Phone: (407) 894-4474
Fax: (407) 894-7032
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 0110-008149 | Virginia |
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA9116218 | Florida |
Profile Details
NPI number | 1992375554 |
---|---|
LBN Legal business name | Hathcock, Samuel Gordon |
Credentials | Physician Assistant (PA) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Jun 28th, 2021 |
Last updated | Jan 16th, 2024 - about 8 months 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1992375554 | NPPES |
Virginia | Other | 0110-008149 | VIRGINIA BOARD OF MEDICINE LICENSE |
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