Provider Demographics
NPI:1073656344
Name:HAMNER, KELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:HAMNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 PHOENIX BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5545
Mailing Address - Country:US
Mailing Address - Phone:678-788-8950
Mailing Address - Fax:678-788-8953
Practice Address - Street 1:1631 PHOENIX BLVD STE 4
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5545
Practice Address - Country:US
Practice Address - Phone:678-788-8950
Practice Address - Fax:678-788-8953
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF67516Medicare UPIN