Provider Demographics
NPI:1992745988
Name:HAMBLIN, DARYL KIM
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:KIM
Last Name:HAMBLIN
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 1:2911 ZELDA RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2648
Mailing Address - Country:US
Mailing Address - Phone:334-262-7787
Mailing Address - Fax:334-262-7795
Practice Address - Street 1:2911 ZELDA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2648
Practice Address - Country:US
Practice Address - Phone:334-262-7787
Practice Address - Fax:334-262-7795
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL627103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1992745988OtherNPI
AL102I685545OtherPTAN