Basic Information
| Provider Information | |||||||||
| NPI: | 1578540340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATMAKER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5126 HOSPITAL DR NE | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300142566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065408146 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5126 HOSPITAL DR NE | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300142566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005326151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 01/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 26300 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 26300 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000325707R | 05 | GA | MEDICAID |