Basic Information
| Provider Information | |||||||||
| NPI: | 1013134816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HADAWAY | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | SAM | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 OSIGIAN BLVD # B | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789535358 | ||||||||
| FaxNumber: | 4789535340 | ||||||||
| Practice Location | |||||||||
| Address1: | 4660 RIVERSIDE PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312101395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784740240 | ||||||||
| FaxNumber: | 4784751340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT001243 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.