Provider Demographics
NPI:1720170335
Name:RHONDA L HAMM
Entity Type:Organization
Organization Name:RHONDA L HAMM
Other - Org Name:WILLOW RIDGE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-645-7503
Mailing Address - Street 1:333 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1116
Mailing Address - Country:US
Mailing Address - Phone:303-645-7503
Mailing Address - Fax:304-645-7582
Practice Address - Street 1:333 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1116
Practice Address - Country:US
Practice Address - Phone:304-645-7503
Practice Address - Fax:304-645-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001633Medicaid
WV3810001633Medicaid