Provider Demographics
NPI:1003074329
Name:HATCHERSON, CLIFTON JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:
Last Name:HATCHERSON
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 WINN WAY
Mailing Address - Street 2:5247 RUNNING DOE DRIVE
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1707
Mailing Address - Country:US
Mailing Address - Phone:404-289-8445
Mailing Address - Fax:404-298-8288
Practice Address - Street 1:445 WINN WAY
Practice Address - Street 2:5247 RUNNING DOE DRIVE
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1707
Practice Address - Country:US
Practice Address - Phone:404-289-8445
Practice Address - Fax:404-298-8288
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO024609-11041C0700X
GACSW0021741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFRSOtherMEDICARE PROVIDER NUMBER