Provider Demographics
NPI:1184008344
Name:HAM, BYERLY VAUGHN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:BYERLY
Middle Name:VAUGHN
Last Name:HAM
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 FORSYTH ST
Mailing Address - Street 2:STE 1B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8638
Mailing Address - Country:US
Mailing Address - Phone:478-394-0690
Mailing Address - Fax:
Practice Address - Street 1:1062 FORSYTH ST STE 1B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8638
Practice Address - Country:US
Practice Address - Phone:478-741-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN215879OtherAPRN NURSING LICENSE