Provider Demographics
NPI:1205348570
Name:HANCOCK, TOMMY
Entity type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SIX FORKS RD
Mailing Address - Street 2:100 B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6458
Mailing Address - Country:US
Mailing Address - Phone:919-809-6104
Mailing Address - Fax:
Practice Address - Street 1:6900 SIX FORKS RD
Practice Address - Street 2:100 B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6458
Practice Address - Country:US
Practice Address - Phone:919-809-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)