=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154600773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. MATTHEW L HATCHELL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2011
-----------------------------------------------------
Last Update Date | 08/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 BROAD RIVER RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-561-0515
-----------------------------------------------------
Fax | 803-750-8128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 RAMBLIN RD
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29170-3837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 12225
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------