Provider Demographics
NPI:1225278914
Name:HAMBY, KENNETH JEROME (DO)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JEROME
Last Name:HAMBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:509 OLDE WATERFORD WAY STE 200
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4126
Practice Address - Country:US
Practice Address - Phone:910-408-1130
Practice Address - Fax:910-408-1135
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4858207Q00000X
MO2019033197207Q00000X
SCDO32953207Q00000X
NC195325207Q00000X
NC2013-02082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine