Provider Demographics
NPI:1013134816
Name:HADAWAY, JOSEPH SAM (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SAM
Last Name:HADAWAY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OSIGIAN BLVD # B
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7880
Mailing Address - Country:US
Mailing Address - Phone:478-953-5358
Mailing Address - Fax:478-953-5340
Practice Address - Street 1:4660 RIVERSIDE PARK BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1395
Practice Address - Country:US
Practice Address - Phone:478-474-0240
Practice Address - Fax:478-475-1340
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0012432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer