Provider Demographics
NPI:1033283361
Name:HAMMETT, REBECCA PEARL (CPNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:PEARL
Last Name:HAMMETT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:PEARL
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:330 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5630
Practice Address - Country:US
Practice Address - Phone:706-238-8030
Practice Address - Fax:706-238-8031
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN161874363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA060685992AMedicaid
GA511I500025Medicare PIN
Q74873Medicare UPIN