Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2029 | SC |
N | 1223P0300X | Periodontist | 2029 | SC |
NPI | 1033251426 |
---|---|
Provider Name | Clarence Thomas Hamrick III |
First Address | Greenville, SC 29615 |
Second Address | Greenville, SC 29615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 16/03/2012 |