MEDICARE: CORY HANCOCK

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	133V00000X	Registered Dietitian	L005162	NC

General Provider Information

NPI Number	:	1861993529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY HANCOCK

Provider Business Mailing Address
First Line	:	300 SUNSET GROVE DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-6809
Country	:	US
Telephone Number	:	607-765-9963
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 FAST PARK DR STE 301
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4853
Country	:	US
Telephone Number	:	919-442-8398
Fax Number	:

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

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	02/27/2018

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