Basic Information
| Provider Information | |||||||||
| NPI: | 1801000153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMES | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 598 3RD ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312013357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786336706 | ||||||||
| FaxNumber: | 4786335384 | ||||||||
| Practice Location | |||||||||
| Address1: | 771 ORANGE ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787499001 | ||||||||
| FaxNumber: | 4787499003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.