1588992887 NPI number — MR. WILLIAM MATTHEW HAMMONDS PT, MS

Table of content: MR. WILLIAM MATTHEW HAMMONDS PT, MS (NPI 1588992887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588992887 NPI number — MR. WILLIAM MATTHEW HAMMONDS PT, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMMONDS
Provider First Name:
WILLIAM
Provider Middle Name:
MATTHEW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588992887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 ROSELANE ST NW
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-7902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-259-5226
Provider Business Mailing Address Fax Number:
267-321-2044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4523 FORSYTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31210-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-254-7010
Provider Business Practice Location Address Fax Number:
478-254-7012
Provider Enumeration Date:
11/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT006441 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT24204 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)