Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 002762 | GA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 70208 | GA |
NPI | 1164609566 |
---|---|
Provider Name | Dr. Kyle Edward Hammond |
First Address | Decatur, GA 30033-5405 |
Second Address | Atlanta, GA 30303-3049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002762 | TEMPORARY LICENSE # (01) | GA |