MEDICARE: MR. DERRICK D HAMMON

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	374U00000X	Home Health Aide	HC4167	NC

General Provider Information

NPI Number	:	1386944692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DERRICK D HAMMON

Provider Business Mailing Address
First Line	:	205 PLAZA DR STE C
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-6752
Country	:	US
Telephone Number	:	919-368-6414
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 PLAZA DR STE C
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-6752
Country	:	US
Telephone Number	:	919-368-6414
Fax Number	:

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

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	11/02/2010

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