Provider Demographics
NPI:1750981114
Name:HATCHER, KEVIN LADD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LADD
Last Name:HATCHER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 AMBERWOOD CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7705
Mailing Address - Country:US
Mailing Address - Phone:770-547-8289
Mailing Address - Fax:
Practice Address - Street 1:1550 RIVERSTONE PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2918
Practice Address - Country:US
Practice Address - Phone:770-479-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist