Provider Demographics
NPI:1295982775
Name:STEPHEN L HAMMERMAN M.D.LLC
Entity type:Organization
Organization Name:STEPHEN L HAMMERMAN M.D.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-859-2973
Mailing Address - Street 1:601 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1758
Mailing Address - Country:US
Mailing Address - Phone:615-859-2973
Mailing Address - Fax:615-851-6797
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1758
Practice Address - Country:US
Practice Address - Phone:615-859-2973
Practice Address - Fax:615-851-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD021578261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3061420Medicaid
TN3061420Medicare PIN
TN3061420Medicaid