Provider Demographics
NPI:1134870199
Name:HAM, DEMOINES TREVON
Entity type:Individual
Prefix:
First Name:DEMOINES
Middle Name:TREVON
Last Name:HAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 FOSTER ST APT C202B
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-2868
Mailing Address - Country:US
Mailing Address - Phone:706-332-1853
Mailing Address - Fax:
Practice Address - Street 1:333 FOSTER ST APT C202B
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2868
Practice Address - Country:US
Practice Address - Phone:706-332-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician