Provider Demographics
NPI:1265593693
Name:HAMMOCK, RONALD MACK (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:MACK
Last Name:HAMMOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-353-9994
Mailing Address - Fax:910-353-5784
Practice Address - Street 1:200 DOCTORS DR
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-353-9994
Practice Address - Fax:910-353-5784
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC26107208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
38850OtherBCBS
NC8938850Medicaid
NC1265593693Medicaid
34D0246363OtherCLIA
C81432Medicare UPIN
NCNCA369AMedicare PIN
NC8938850Medicaid