MEDICARE: RONALD MACK HAMMOCK MD

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	208800000X	Urology Physician	26107	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	38850	OTHER	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	34D0246363	OTHER	CLIA

General Provider Information

NPI Number	:	1265593693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD MACK HAMMOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 602484
Second Line	:	SUITE C
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2484
Country	:	US
Telephone Number	:	910-353-9994
Fax Number	:	910-353-5784

Provider Business Practice Location Address
First Line	:	200 DOCTORS DR
Second Line	:	SUITE C
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6308
Country	:	US
Telephone Number	:	910-353-9994
Fax Number	:	910-353-5784

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/03/2016

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