=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811928724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN MANAGEMENT CENTER OF NORTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 01/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2089 SOUTHRIDGE DR
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-6478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-407-0801
-----------------------------------------------------
Fax | 662-407-0807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11407
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35246-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-897-6169
-----------------------------------------------------
Fax | 800-897-6170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GEORGE MONROE HAMMITT III
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 662-407-0801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP3300X
-----------------------------------------------------
Taxonomy Name | Pain Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------