Provider Demographics
NPI:1952307993
Name:HADDOCK, AMOS EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMOS
Middle Name:EARL
Last Name:HADDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602381
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2381
Mailing Address - Country:US
Mailing Address - Phone:828-586-7451
Mailing Address - Fax:828-586-7453
Practice Address - Street 1:80 HEALTHCARE DR
Practice Address - Street 2:STE 201
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5126
Practice Address - Country:US
Practice Address - Phone:828-586-7451
Practice Address - Fax:828-586-7453
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC29475207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC84247Medicare UPIN
NC206904EMedicare ID - Type Unspecified
NC8938042Medicaid