Provider Demographics
NPI:1700067642
Name:HAMM, ROBERT WALTER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:HAMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL CIR
Mailing Address - Street 2:STE. 202
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4504
Mailing Address - Country:US
Mailing Address - Phone:731-644-8441
Mailing Address - Fax:731-644-8442
Practice Address - Street 1:300 HOSPITAL CIR
Practice Address - Street 2:STE. 202
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4504
Practice Address - Country:US
Practice Address - Phone:731-644-8441
Practice Address - Fax:731-644-8442
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2967152084P0800X
TN479612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001067Medicaid
TN103I269095Medicare PIN