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General NPI Number Information
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NPI Number | 1609122563
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Entity Type | Individual
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Provider Name | JOHN STEPHEN HASAK ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 301 TUNIS RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-4204
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Country | US
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Telephone | 770-954-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 5109 HADDON PL
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City | MCDONOUGH
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State | GA
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Zip | 30253-6933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AT002057
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License Number State | GA
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