Provider Demographics
NPI:1053505909
Name:HAM, BRIAN C (ARNP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:HAM
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324-1303
Mailing Address - Country:US
Mailing Address - Phone:850-663-4643
Mailing Address - Fax:850-663-2350
Practice Address - Street 1:409 HIGH ST
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-1303
Practice Address - Country:US
Practice Address - Phone:850-663-4643
Practice Address - Fax:850-663-2350
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3033052363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health