Individual
GARY S HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
590 NANCY ST NW, MARIETTA, GA 30060-1334
(770) 423-0395
(770) 499-0352
Mailing address
590 NANCY ST NW, MARIETTA, GA 30060-1334
(770) 423-0395
(770) 499-0352
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
042599
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00744961D
—
GA
01
—
020042822
RAILROAD MEDICARE ID
GA
01
—
52636051-004
BC/BS ID
GA
01
—
5647403
AETNA PPO ID
GA
01
—
565113
AETNA HMO
GA
Enumeration date
05/01/2006
Last updated
12/03/2019
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