Provider Demographics
NPI:1073242053
Name:HAM, SHAWN AUSTIN
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:AUSTIN
Last Name:HAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MOORE ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28333-5329
Mailing Address - Country:US
Mailing Address - Phone:919-750-9900
Mailing Address - Fax:
Practice Address - Street 1:116 MOORE ALLEN ST
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:NC
Practice Address - Zip Code:28333-5329
Practice Address - Country:US
Practice Address - Phone:919-750-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1057107754OtherHUMANA MILITARY