Provider Demographics
NPI:1720038037
Name:HAMMETT, ERIC BRADLEY (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:BRADLEY
Last Name:HAMMETT
Suffix:
Gender:M
Credentials:CRNA
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 410
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0410
Mailing Address - Country:US
Mailing Address - Phone:800-749-2940
Mailing Address - Fax:888-820-1824
Practice Address - Street 1:865 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0210
Practice Address - Country:US
Practice Address - Phone:912-427-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158200367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA227923181CMedicaid
GA227923181BMedicaid
GAP00379304OtherRAILROAD MEDICARE
GA227923181AMedicaid
GAP00379304OtherRAILROAD MEDICARE