Healthcare Provider Details

I. General information

NPI: 1457272809
Provider Name (Legal Business Name): MS. MADISON RAE HAMM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S KERR AVE
WILMINGTON NC
28403-8425
US

IV. Provider business mailing address

4149 ABBINGTON TER
WILMINGTON NC
28403-5578
US

V. Phone/Fax

Practice location:
  • Phone: 910-782-3499
  • Fax:
Mailing address:
  • Phone: 910-387-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: