Provider Demographics
NPI:1760461925
Name:HATHAWAY, JOSEPH M JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:HATHAWAY
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 1:114 HILL POND LN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0872
Mailing Address - Country:US
Mailing Address - Phone:912-681-6944
Mailing Address - Fax:912-681-8744
Practice Address - Street 1:1497 FAIR RD STE 104
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0822
Practice Address - Country:US
Practice Address - Phone:912-486-1600
Practice Address - Fax:912-871-3342
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049797207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900501GMedicaid
GA000900501GMedicaid
GA10BBCJTMedicare ID - Type Unspecified