Provider Demographics
NPI:1174735906
Name:CLAREMONT FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:CLAREMONT FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-459-4445
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28610-0580
Mailing Address - Country:US
Mailing Address - Phone:828-459-4445
Mailing Address - Fax:828-459-4434
Practice Address - Street 1:3221 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NC
Practice Address - Zip Code:28610-9692
Practice Address - Country:US
Practice Address - Phone:828-459-4445
Practice Address - Fax:828-459-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012JFMedicaid
NC0234LOtherBCBS OF NC
NC23571COtherMEDCOST
NC0234LOtherBCBS OF NC