Provider Demographics
NPI:1891845392
Name:HAMAD, NADIA MARYAM (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:NADIA
Middle Name:MARYAM
Last Name:HAMAD
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 OLIVE ST
Mailing Address - Street 2:APT 3
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3404
Mailing Address - Country:US
Mailing Address - Phone:870-680-8308
Mailing Address - Fax:
Practice Address - Street 1:ATHLETIC MEDICINE
Practice Address - Street 2:FOOTBALL STADIUM
Practice Address - City:STATE UNIVERSITY
Practice Address - State:AR
Practice Address - Zip Code:72467
Practice Address - Country:US
Practice Address - Phone:870-972-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer