Provider Demographics
NPI:1659382059
Name:HAMMILL, WILLIAM WALLACE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALLACE
Last Name:HAMMILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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:704-384-7840
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3261
Practice Address - Country:US
Practice Address - Phone:704-316-1220
Practice Address - Fax:704-316-1230
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-001882080P0202X
VA01010491452080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1515JOtherBCBS
VA060055253Medicare PIN
VA060000949Medicare PIN
NC1515JOtherBCBS