Healthcare Provider Details

I. General information

NPI: 1104886928
Provider Name (Legal Business Name): THOMAS JAMES HATTEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTH JOHNSON STREET
COATS NC
27521
US

IV. Provider business mailing address

25 N. JOHNSON ST.
COATS NC
27521
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-6423
  • Fax: 910-897-2540
Mailing address:
  • Phone: 910-897-6423
  • Fax: 910-897-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02613
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200800345
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: