MEDICARE: DR. ADDISON WARDLAW HAMRICK D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6913	SC

General Provider Information

NPI Number	:	1033425665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADDISON WARDLAW HAMRICK D.M.D.

Provider Business Mailing Address
First Line	:	105 N JOHNSON ST
Second Line	:
City	:	GAFFNEY
State	:	SC
Zip	:	29340-3127
Country	:	US
Telephone Number	:	864-489-0375
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 N JOHNSON ST
Second Line	:
City	:	GAFFNEY
State	:	SC
Zip	:	29340-3127
Country	:	US
Telephone Number	:	864-489-0375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	05/04/2016

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