=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093774820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUGH WHITMAN HARLING III EDD, LAT, ATC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5400 RAMSEY ST
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28311-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-630-7418
-----------------------------------------------------
Fax | 910-630-7676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2291 JENNA SHANE DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-482-8263
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 0501
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------