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Individual
SAMUEL GORDON HATHCOCK
Active
Individual
SAMUEL GORDON HATHCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110-008149
VA
363A00000X
Physician Assistant
Primary
PA9116218
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110-008149
VIRGINIA BOARD OF MEDICINE LICENSE
VA
Enumeration date
06/28/2021
Last updated
01/16/2024
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