Provider Demographics
NPI:1326165242
Name:HAMMETT, JOHN VINCENT III (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
Last Name:HAMMETT
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 EDISTO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2730
Mailing Address - Country:US
Mailing Address - Phone:803-279-6562
Mailing Address - Fax:
Practice Address - Street 1:1021 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-3158
Practice Address - Country:US
Practice Address - Phone:706-828-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002219225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant