Stacey Allen Hathcock, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5830 Issued in GA

Practice address

307 Third Avenue
Crisp Regional Therapies
Cordele, GA 31015

Phone

(229) 271-4612

Fax

(229) 271-4616

NPI assigned

Jun 1, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southwest Georgia Rehab, IncGroup PAC ID 6204966740, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southwest Georgia Rehab, Inc

  • Physical Therapist
  • Cordele, GA
  • NPI 1902120587
  Medicare reassignment Care Compare group NPD Authorized official
• Crisp Regional Hospital Inc

  • General Acute Care Hospital
  • Cordele, GA
  • NPI 1700851649
  NPD (past)
• Therapy Resource Network, Inc.

  • Physical Therapist
  • Cordele, GA
  • NPI 1134441041
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260403200000",
    "number": "1083816243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 EASTWOOD LAKE DR",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310155933",
            "telephone_number": "229-271-3760",
            "fax_number": "229-271-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 THIRD AVENUE",
            "address_2": "CRISP REGIONAL THERAPIES",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "31015",
            "telephone_number": "229-271-4612",
            "fax_number": "229-271-4616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHCOCK",
        "first_name": "STACEY",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-01",
        "last_updated": "2009-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "5830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474753088A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Paul Hamilton, MS, ATC, LAT
• Hanger Prosthetics & Orthotics Inc
• Laycee Sumner Harris, RN
• Hartfield Clinics LLC
• Katherine Hashimoto, DPT
• Danielle K Hedden, FNP-C
• Monica Helton, RN
• Rylee Henderson
• Melanie Marie Henson, LPC
• Shkelia Herbert

• Physical Therapist in Cordele, GA
• Providers in Cordele, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.