=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639524432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMMETT CLINIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2016
-----------------------------------------------------
Last Update Date | 10/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3710 LANDMARK DR SUITE 114
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29204-4062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-391-5918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3710 LANDMARK DR SUITE 114
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29204-4062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-391-5918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID HALL HAMMETT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 803-467-8969
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 26144
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------