Healthcare Provider Details

I. General information

NPI: 1386017903
Provider Name (Legal Business Name): CD HAMMOND ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 LYNN RD SUITE G
TRYON NC
28782-6855
US

IV. Provider business mailing address

PO BOX 677
COLUMBUS NC
28722-0677
US

V. Phone/Fax

Practice location:
  • Phone: 828-817-4734
  • Fax:
Mailing address:
  • Phone: 828-817-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number#646
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. CYNTHIA LYNN MILLIGAN
Title or Position: PRESIDENT
Credential: DOM
Phone: 828-817-4734