Healthcare Provider Details

I. General information

NPI: 1912478140
Provider Name (Legal Business Name): NIMA JOHN HAMI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CURTIS ELLIS DR
ROCKY MOUNT NC
27804-2237
US

IV. Provider business mailing address

210 TOWNE VILLAGE DR
CARY NC
27513-8910
US

V. Phone/Fax

Practice location:
  • Phone: 252-962-8020
  • Fax:
Mailing address:
  • Phone: 919-859-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006660
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001009372
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: