Provider Demographics
NPI:1740428010
Name:HATHAWAY, GEORGE R
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:R
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12197 PEVERO
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1106
Mailing Address - Country:US
Mailing Address - Phone:714-389-2857
Mailing Address - Fax:
Practice Address - Street 1:12197 PEVERO
Practice Address - Street 2:
Practice Address - City:TUSTIN RANCH
Practice Address - State:CA
Practice Address - Zip Code:92782-1106
Practice Address - Country:US
Practice Address - Phone:714-389-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies