Basic Information
| Provider Information | |||||||||
| NPI: | 1659555654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMM | ||||||||
| FirstName: | EMILE | ||||||||
| MiddleName: | VICTOR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 MULBERRY BND | ||||||||
| Address2: | |||||||||
| City: | JONESBOROUGH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239431343 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CORNER OF LAMONT AND SYDNEY STREET BLDG 160 | ||||||||
| Address2: | JAMES H. QUILLEN VAMC | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | 4239793528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | MD0000016821 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.