Individual
MR. GREGORY DALE HAWTHORNE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
JENISON FIELDHOUSE, MICHIGAN STATE UNIVERSITY, EAST LANSING, MI 48823
(517) 355-1627
Mailing address
4495 HERITAGE AVE APT B3, OKEMOS, MI 48864-3309
(734) 834-7862
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/05/2007
Last updated
07/08/2007
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