Provider Demographics
NPI:1578598140
Name:HAMMOND, MYRNA (CPNP)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:
Other - Last Name:BARTON (MAIDEN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:274 BIG A RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6002
Practice Address - Country:US
Practice Address - Phone:706-886-8419
Practice Address - Fax:706-827-5083
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN079839208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics