Randy S Hathorn, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2016 83 Issued in MS

Practice address

218 A Gen Robert E Blount Dr
Bassfield, MS 39421-0549

Phone

(601) 943-5426

Fax

(601) 943-6143

NPI assigned

Aug 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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 MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Randy S. Hathorn D.M.D

  • Dentist
  • Bassfield, MS
  • NPI 1528242351
  NPD (past) Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912018748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "BASSFIELD",
            "state": "MS",
            "postal_code": "394210549",
            "telephone_number": "601-943-5126",
            "fax_number": "601-943-6143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 A GEN ROBERT E BLOUNT DR",
            "city": "BASSFIELD",
            "state": "MS",
            "postal_code": "394210549",
            "telephone_number": "601-943-5426",
            "fax_number": "601-943-6143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHORN",
        "first_name": "RANDY",
        "middle_name": "S",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2016 83",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00060050",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert H Carr, RPH
• Chloe Elayne Crittenden, COTA
• Amanda Courtney Easterling, LPN
• Express Care Transportation LLC
• Family Health Care Clinic, Inc.
• Iconic Homecare LLC
• Kingdom Home Care and Nursing Services LLC
• Martha's Care Pca Agency
• NE Trans Care, LLC
• New Point Pharmacy Inc. (Newpointe Pharmacy #2)

• General Practice Dentistry in Bassfield, MS
• Providers in Bassfield, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.