Male or Other

Samuel G. Hathcock PA

Physician Assistant in Celebration, FL(View on Map)

Full Name

Samuel Gordon Hathcock PA

NPI Number

1992375554

NPI Type

Individual Provider

Gender

Male

Enumeration Date

06/28/2021

Specialties

(Taxonomies)

Code

363A00000X

Primary Taxonomy

Yes

Licenses

State

Florida
Virginia

License Number

PA9116218
0110-008149

Contact
Information

Purpose

Mailing
Location

Address

4645 NW 8TH AVE
410 CELEBRATION PL STE 300

City

Gainesville
Celebration

State

FL
FL

Postal Code

32605-4687
34747-5434

Country

US
US

Telephone Number

(352) 375-1212
(407) 894-4474

Identifiers

Identifier

0110-008149

Identifier State

VA

Identifier Issuer

VIRGINIA BOARD OF MEDICINE LICENSE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 01/16/2024

Provider Address

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