Healthcare Provider Details

I. General information

NPI: 1023336906
Provider Name (Legal Business Name): JONATHAN W HATHAWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SHAKERAG HL STE 201
PEACHTREE CITY GA
30269-4047
US

IV. Provider business mailing address

4000 SHAKERAG HL STE 201
PEACHTREE CITY GA
30269-4047
US

V. Phone/Fax

Practice location:
  • Phone: 770-486-7111
  • Fax:
Mailing address:
  • Phone: 770-486-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number87985
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: