Organization
ALFRED W. HATHORN JR., M.D. APMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH A HATHORN (OFFICE MANAGER)
(318) 686-8197
Entity
Organization
Contact information
Practice address
2120 BERT KOUN LOOP, SUITE # L, SHREVEPORT, LA 71118-3351
(318) 686-8197
(318) 688-5962
Mailing address
2120 BERT KOUN LOOP, SUITE # L, SHREVEPORT, LA 71118-3351
(318) 686-8197
(318) 688-5962
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
011400
LA
363LA2100X
Acute Care Nurse Practitioner
AP06110
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1135127
—
LA
05
—
2315889
—
LA
Enumeration date
05/28/2014
Last updated
05/28/2014
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