Provider Demographics
NPI:1700815545
Name:DARYL K. HAMBLIN, PH.D., PC
Entity Type:Organization
Organization Name:DARYL K. HAMBLIN, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-288-9009
Mailing Address - Street 1:1040 LONGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8055
Mailing Address - Country:US
Mailing Address - Phone:334-288-9009
Mailing Address - Fax:334-288-9497
Practice Address - Street 1:1040 LONGFIELD CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8055
Practice Address - Country:US
Practice Address - Phone:334-288-9009
Practice Address - Fax:334-288-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK871OtherMEDICARE GROUP NUMBER
AL167688600OtherOWCP PROVIDER NUMBER
ALR36291Medicare UPIN
ALK871OtherMEDICARE GROUP NUMBER