Provider Demographics
NPI:1225023104
Name:HAMATI, FAWWAZ I (MD)
Entity Type:Individual
Prefix:
First Name:FAWWAZ
Middle Name:I
Last Name:HAMATI
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 1:310 N STATE OF FRANKLIN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6008
Mailing Address - Country:US
Mailing Address - Phone:423-979-6000
Mailing Address - Fax:423-979-6011
Practice Address - Street 1:310 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6008
Practice Address - Country:US
Practice Address - Phone:423-979-6000
Practice Address - Fax:423-979-6011
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD21253207RC0000X
TN21253207R00000X, 207RI0011X
VA0101220430207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7906583Medicaid
TNTN0111OtherUNITED HEALTHCARE OF THE
0020583100OtherBLACK LUNG
VA5824702Medicaid
0004575129OtherAETNA
TNP01368158OtherRAILROAD MEDICARE
VA1225023104Medicaid
TN3081422Medicaid
TN3081427Medicaid
TN3094949OtherBLUE CROSS BLUE SHIELD
060049771OtherRAIL ROAD MEDICARE
KY64927205Medicaid
VA5824702Medicaid
TNTN0111OtherUNITED HEALTHCARE OF THE
VA1225023104Medicaid
TN3081422Medicaid
TN621490616OtherTIN