Provider Demographics
NPI:1871846170
Name:HAMRICK, THERESA (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:HAMRICK
Suffix:
Gender:F
Credentials:CPNP
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 200429
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-9008
Mailing Address - Country:US
Mailing Address - Phone:770-386-3011
Mailing Address - Fax:770-386-4966
Practice Address - Street 1:958 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2158
Practice Address - Country:US
Practice Address - Phone:770-386-3011
Practice Address - Fax:770-386-4966
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195922363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0003129535AMedicaid