Basic Information
| Provider Information | |||||||||
| NPI: | 1578560538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMITT | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | MONROE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2089 SOUTHRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388016478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624070801 | ||||||||
| FaxNumber: | 6624070807 | ||||||||
| Practice Location | |||||||||
| Address1: | 2089 SOUTHRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388016478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624070801 | ||||||||
| FaxNumber: | 6624070807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2005 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 14417 | MS | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00116578 | 05 | MS | MEDICAID |