Provider Demographics
NPI:1750355038
Name:HAMMOND, DOUGLAS ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:HAMMOND
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 1:6029 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2112
Mailing Address - Country:US
Mailing Address - Phone:901-726-1056
Mailing Address - Fax:901-726-5867
Practice Address - Street 1:6029 WALNUT GROVE RD
Practice Address - Street 2:SUITE 404
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-726-1056
Practice Address - Fax:901-726-5867
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000029896208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38665371Medicaid
TNP00636087OtherRAILROAD MEDICARE
TNG29000Medicare UPIN
TN38665371Medicaid