MEDICARE: DR. DAVID ALDEN HATHEWAY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6197	AL

General Provider Information

NPI Number	:	1598147449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALDEN HATHEWAY DMD

Provider Business Mailing Address
First Line	:	230 E 10TH ST
Second Line	:	SUITE 106
City	:	ANNISTON
State	:	AL
Zip	:	36207-5784
Country	:	US
Telephone Number	:	256-741-7340
Fax Number	:

Provider Business Practice Location Address
First Line	:	5412 MONTGOMERY HWY STE 8
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-1657
Country	:	US
Telephone Number	:	334-983-1730
Fax Number	:	334-983-1725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	01/22/2016

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