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:
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Health care specialties

SpecialtyCodeLicense #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 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992375554 NPPES
Virginia Other 0110-008149 VIRGINIA BOARD OF MEDICINE LICENSE

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