Provider Demographics
NPI:1568517902
Name:HAMMOND-WICKFALL, DEBORAH F (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:F
Last Name:HAMMOND-WICKFALL
Suffix:
Gender:F
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:PO BOX 54454
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-0454
Mailing Address - Country:US
Mailing Address - Phone:404-265-6322
Mailing Address - Fax:404-265-6321
Practice Address - Street 1:315 BOULEVARD NE
Practice Address - Street 2:SUITE 520
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1200
Practice Address - Country:US
Practice Address - Phone:404-265-6322
Practice Address - Fax:404-265-6321
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00161487OtherRR MEDICARE PIN
GA832158OtherBCBS PROVIDER I.D. #
GADC3236OtherRR MEDICARE GROUP I.D. #
GAD45539Medicare UPIN
GAGRP6599Medicare ID - Type UnspecifiedGROUP PROVIDER I.D. #
GA832158OtherBCBS PROVIDER I.D. #