Provider Demographics
NPI:1669767463
Name:HATFIELD, JOHNNA LEEANN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHNNA
Middle Name:LEEANN
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 THE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5221
Mailing Address - Country:US
Mailing Address - Phone:864-968-8811
Mailing Address - Fax:864-968-8814
Practice Address - Street 1:301 THE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5221
Practice Address - Country:US
Practice Address - Phone:864-968-8811
Practice Address - Fax:864-968-8814
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist