Healthcare Provider Details

I. General information

NPI: 1285329482
Provider Name (Legal Business Name): ALEXANDERCECIL K HATANAKA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 TOWN CENTER PLAZA
MILL CREEK WV
26280
US

IV. Provider business mailing address

116 WOODLEIGH RD
DOTHAN AL
36305-1033
US

V. Phone/Fax

Practice location:
  • Phone: 304-335-2050
  • Fax:
Mailing address:
  • Phone: 435-218-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4983
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: