Provider Demographics
NPI:1477843407
Name:HAMMOCK, ANTONIUS DEMOND I
Entity Type:Individual
Prefix:
First Name:ANTONIUS
Middle Name:DEMOND
Last Name:HAMMOCK
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W SILVER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-1336
Mailing Address - Country:US
Mailing Address - Phone:405-201-2551
Mailing Address - Fax:405-741-0275
Practice Address - Street 1:909 W SILVER MEADOW DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-1336
Practice Address - Country:US
Practice Address - Phone:405-201-2551
Practice Address - Fax:405-741-0275
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health