Provider Demographics
NPI:1497377303
Name:HATTIER, GEORGETTE AMANDA (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGETTE
Middle Name:AMANDA
Last Name:HATTIER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2721
Mailing Address - Country:US
Mailing Address - Phone:302-542-5971
Mailing Address - Fax:
Practice Address - Street 1:13701 E MISSISSIPPI AVE STE 320
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6142
Practice Address - Country:US
Practice Address - Phone:303-340-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT220250390200000X
CODR.0072450207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program