Provider Demographics
NPI:1588807689
Name:HAMANN, GAYLE (DO)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:HAMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 RENNOC RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1816
Mailing Address - Country:US
Mailing Address - Phone:423-419-0258
Mailing Address - Fax:
Practice Address - Street 1:146 COLD CREEK DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-2892
Practice Address - Country:US
Practice Address - Phone:423-419-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2024-03-05
Deactivation Date:2024-01-18
Deactivation Code:
Reactivation Date:2024-01-29
Provider Licenses
StateLicense IDTaxonomies
WAOP60189887208D00000X
TNDO0000003439208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice