Michael Quentin Hazelwood, MSA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

0136000590 Issued in VA

Practice address

2204 Wilborn Ave
South Boston, VA 24592-1645

Phone

(434) 517-3100

NPI assigned

Mar 11, 2025

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1741651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1942009196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 SLAYTON RD",
            "city": "SUTHERLIN",
            "state": "VA",
            "postal_code": "245943121",
            "telephone_number": "434-334-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "434-517-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZELWOOD",
        "first_name": "MICHAEL",
        "middle_name": "QUENTIN",
        "credential": "MSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-11",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "VA",
            "license": "0136000590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Hamlette, MS, LPC, CSAC
• Gahear F Hamlor, MD
• Whitney Minter Harrell, FNP
• Samantha Renee Harris
• Michael Kent Haskett, OD
• Amy Elizabeth Henderson, SLP-CF
• Kelly Henderson
• Chad Michael Henry, M.D.
• Here and There Medical Transport LLC
• William Jeffries Hill Jr.

• All providers in South Boston, VA
• Surgical Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.