| Randy S. Hathorn D.m.d | |
|
218 Gen Robert E Blount A Bassfield MS 39421-0549 | |
| (601) 943-5126 | |
| (601) 943-6143 |
| Full Name | Randy S. Hathorn D.m.d |
|---|---|
| Speciality | Dentist |
| Location | 218 Gen Robert E Blount, Bassfield, Mississippi |
| Authorized Official Name and Position | Randy S Hathorn (OWNER) |
| Authorized Official Contact | 6019435126 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randy S. Hathorn D.m.d Po Box 549 Bassfield MS 39421-0549 Ph: (601) 943-5126 | Randy S. Hathorn D.m.d 218 Gen Robert E Blount A Bassfield MS 39421-0549 Ph: (601) 943-5126 |
| NPI Number | 1528242351 |
|---|---|
| Provider Enumeration Date | 12/28/2007 |
| Last Update Date | 12/28/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528242351 | NPI | - | NPPES |
| 03556870 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2016-83 (Mississippi) | Primary |
| 122300000X | Dentist | 3361-05 (Mississippi) | Secondary |
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