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)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