Individual
JACKSON E HATFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2621 E PINETREE BLVD, THOMASVILLE, GA 31792-4840
(229) 584-4100
Mailing address
900 CAIRO RD, THOMASVILLE, GA 31792-4255
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
076616
GA
207Q00000X
Family Medicine Physician
MD.205947
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04929309
—
MS
05
—
2150405
—
LA
Enumeration date
04/19/2011
Last updated
08/03/2020
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