Healthcare Provider Details

I. General information

NPI: 1376803304
Provider Name (Legal Business Name): ANTHONY GARRETT HAZELTON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 GASHES CREEK RD
ASHEVILLE NC
28803-9405
US

IV. Provider business mailing address

PO BOX 1869
FLETCHER NC
28732-1869
US

V. Phone/Fax

Practice location:
  • Phone: 828-650-8232
  • Fax:
Mailing address:
  • Phone: 828-687-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4316
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number102966
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: