Provider Demographics
NPI:1386944692
Name:HAMMON, DERRICK D
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:D
Last Name:HAMMON
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 1:205 PLAZA DR STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6752
Mailing Address - Country:US
Mailing Address - Phone:919-368-6414
Mailing Address - Fax:
Practice Address - Street 1:205 PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6752
Practice Address - Country:US
Practice Address - Phone:919-368-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4167374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide