Healthcare Provider Details

I. General information

NPI: 1588641880
Provider Name (Legal Business Name): LETITIA MARIE HAZEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GARNER RD
RALEIGH NC
27610-0114
US

IV. Provider business mailing address

PO BOX 696
HAMPSTEAD NC
28443
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-6131
  • Fax: 919-571-2932
Mailing address:
  • Phone: 910-791-6767
  • Fax: 910-791-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200101342
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number200101342
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: