=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639595044
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA OLIVIA THOMPSON HATCHER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2014
-----------------------------------------------------
Last Update Date | 09/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1365 CLIFTON RD NE SUITE C1152
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30322-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-778-1900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1802 NEW YORK AVE NE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30307-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-260-6490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 007122
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------