MEDICARE: PATRICIA WELLBORN HAMPTON DMD

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	DN010255	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447395173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA WELLBORN HAMPTON DMD

Provider Business Mailing Address
First Line	:	PO BOX 175
Second Line	:
City	:	ARMUCHEE
State	:	GA
Zip	:	30105-0175
Country	:	US
Telephone Number	:	706-292-0777
Fax Number	:	706-292-9428

Provider Business Practice Location Address
First Line	:	5490 MARTHA BERRY HWY NE
Second Line	:
City	:	ARMUCHEE
State	:	GA
Zip	:	30105-2302
Country	:	US
Telephone Number	:	706-292-0777
Fax Number	:	706-292-9428

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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