Provider Demographics
NPI:1942275425
Name:HAMM, MICHAEL K (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:HAMM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 VILLAGE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-4192
Mailing Address - Country:US
Mailing Address - Phone:912-223-9268
Mailing Address - Fax:
Practice Address - Street 1:1044 VILLAGE OAKS LN
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4192
Practice Address - Country:US
Practice Address - Phone:912-223-9268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049021208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000879414EMedicaid
GA813193OtherBLUE CROSS BLUE SHIELD
GA000879414EMedicaid
GA93BDQDNMedicare ID - Type Unspecified