Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | LL33643 | SC |
N | 111NI0900X | Internist | LL33643 | SC |
N | 207RH0000X | Hematologist | 33643 | SC |
Y | 207RH0003X | Hematology & Oncology | 33643 | SC |
NPI | 1225322431 |
---|---|
Provider Name | Amanda Redden Hathaway |
First Address | Atlanta, GA 30374-3070 |
Second Address | Spartanburg, SC 29303-3040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
336434 | (05) | SC |
SCA6833365 | MEDICARE PIN (01) | SC |
SCA6834746 | MEDICARE PIN (01) | SC |