Provider Demographics
NPI:1164559035
Name:ASA Q HATFIELD JR MD INC PA
Entity Type:Organization
Organization Name:ASA Q HATFIELD JR MD INC PA
Other - Org Name:HATFIELD CLINIC FOR FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-227-8308
Mailing Address - Street 1:210 OVERLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646
Mailing Address - Country:US
Mailing Address - Phone:864-227-8308
Mailing Address - Fax:
Practice Address - Street 1:210 OVERLAND DRIVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-227-8308
Practice Address - Fax:864-227-9864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC121807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC121807Medicaid
SCD17840Medicare UPIN