Provider Demographics
NPI:1316349178
Name:HAMILTON, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 BRADY STREET EXT
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-8705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1510 E DIXIE DR STE G
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8893
Practice Address - Country:US
Practice Address - Phone:336-633-4327
Practice Address - Fax:336-633-4327
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1217237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist