Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 057474 | GA |
N | 208600000X | Surgeon | 057474 | GA |
N | 2086S0129X | Vascular Surgeon | 057474 | GA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 057474 | GA |
NPI | 1174506869 |
---|---|
Provider Name | Dr. John C Hastings |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
886170982A | (05) | GA |
E83711 | (02) | GA |