Individual
DR. EDMOND EARL HATTAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2080 FAIRBURN ROAD, SUITE F, DOUGLASVILLE, GA 30135-1064
(770) 489-0187
(770) 920-0364
Mailing address
PO BOX 1171, DOUGLASVILLE, GA 30133-1171
(770) 489-0187
(770) 920-0364
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR002812
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55001148A
—
GA
Enumeration date
11/08/2006
Last updated
06/07/2012
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