Healthcare Provider Details

I. General information

NPI: 1750219093
Provider Name (Legal Business Name): MR. CLARK DANIEL HITCHCOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BYARS HEALTH CLINIC WOMACK ARMY MEDICAL CENTER 2864 WOODRUFF STREET
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

204 DAIRY CT
RAEFORD NC
28376-7548
US

V. Phone/Fax

Practice location:
  • Phone: 910-643-7288
  • Fax:
Mailing address:
  • Phone: 210-919-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberP511379
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: