Provider Demographics
NPI:1649437633
Name:HATFIELD, SAMANTHA L (MD)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:L
Last Name:HATFIELD
Suffix:
Gender:F
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:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-0839
Mailing Address - Country:US
Mailing Address - Phone:870-886-3211
Mailing Address - Fax:870-886-9027
Practice Address - Street 1:1309 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-0839
Practice Address - Country:US
Practice Address - Phone:870-886-3211
Practice Address - Fax:870-886-9027
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7521207R00000X, 208000000X
ARE7521207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR195749001Medicaid
AR195749001Medicaid