Healthcare Provider Details

I. General information

NPI: 1154365120
Provider Name (Legal Business Name): WILLIAM G HATHAWAY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 11TH ST NE
SPRINGHILL LA
71075-4503
US

IV. Provider business mailing address

401 11TH ST NE
SPRINGHILL LA
71075-4503
US

V. Phone/Fax

Practice location:
  • Phone: 318-539-1701
  • Fax: 318-539-1737
Mailing address:
  • Phone: 318-539-1701
  • Fax: 318-539-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202477
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: