Clio Hamilton Austin, MD
Individual provider Active NPI Pediatrics Physician · Mocksville, NC
NPI 1841287638 · NPPES record last updated Dec 15, 2016
Key facts
- NPI
- 1841287638
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 2006-01137 (NC)
- Practice address
- 113 Market Place Dr
Mocksville, NC 27028-2084 - Phone
- (336) 713-4224
- Fax
- (336) 753-8248
- NPI assigned
- Oct 5, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061121000629 | NC | Practitioner - Pediatric Medicine | 0749224251 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006-01137 | NC | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wake Forest University Health Sciences | Current |
Accepting new patients | |
| Wake Forest University Health Sciences | Current |
Accepting new patients |
Locations
113 Marketplace Dr
Mocksville, NC 27028
Phone (336) 753-6630
1930 N Peace Haven Rd
Winston Salem, NC 27106
Phone (336) 760-5400
Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2006-01137 | NC | Yes |
Addresses
Primary practice location
113 Market Place Dr
Mocksville, NC 27028-2084
Mailing address
PO Box 344
Winston Salem, NC 27102-0344
Phone (336) 716-2011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5904739 | Medicaid | NC |
Other providers in Mocksville, NC
- Crystal Dawn Albery
- Andrew J Rivers, DMD PA
- Teena Jose Antony
- Kevin J Armbrecht
- Christopher Britt Atkins
- Autumn Corporation
- Autumn Corporation
- Samantha Bryanna-Norabuena Bahena
- Jenna Kay Baker
- Graydon Balch
All providers in Mocksville, NC · Pediatrics Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.