Provider Demographics
NPI:1093088635
Name:WILLIAM D HAMMONDS, MD
Entity Type:Organization
Organization Name:WILLIAM D HAMMONDS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SCHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-729-7229
Mailing Address - Street 1:102 LAKESHORE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3874
Mailing Address - Country:US
Mailing Address - Phone:912-729-7229
Mailing Address - Fax:912-525-3190
Practice Address - Street 1:102 LAKESHORE DR
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3874
Practice Address - Country:US
Practice Address - Phone:912-729-7229
Practice Address - Fax:912-525-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14053261QH0100X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service