Provider Demographics
NPI:1679503874
Name:HATFIELD, ASA Q JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ASA
Middle Name:Q
Last Name:HATFIELD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4091
Mailing Address - Country:US
Mailing Address - Phone:864-227-8308
Mailing Address - Fax:864-227-9864
Practice Address - Street 1:210 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4091
Practice Address - Country:US
Practice Address - Phone:864-227-8308
Practice Address - Fax:864-227-9864
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC121807Medicaid
SCD178400281Medicare ID - Type Unspecified
D17840Medicare UPIN