=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053534446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMLET PODIATRY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 10/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 WILLIAMS STREET
-----------------------------------------------------
City | HAMLET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28345-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-582-0007
-----------------------------------------------------
Fax | 910-582-8070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 2328
-----------------------------------------------------
City | ROCKINGHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28380-8328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-582-0007
-----------------------------------------------------
Fax | 910-582-8070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | MR. REMBERT ALPHONSO CRAWFORD
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 910-582-0007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 341
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------