=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962706770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUNTER HEARN MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2011
-----------------------------------------------------
Last Update Date | 01/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4111 CAPITOL ST SUITE A
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27704-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-499-1588
-----------------------------------------------------
Fax | 919-477-1688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4111 CAPITOL ST SUITE A
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27704-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-499-1588
-----------------------------------------------------
Fax | 919-477-1688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PHYSICIAN
-----------------------------------------------------
Name | DR. HUNTER ALVERT HEARN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 866-499-1588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084S0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 2010-01857
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------