Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 53238 | TN |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 53238 | TN |
NPI | 1821330895 |
---|---|
Provider Name | Shawn Michael Hamm |
First Address | Bartlett, TN 38134-2875 |
Second Address | Bartlett, TN 38134-2875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2013 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07733768 | (05) | MS |
1821330895 | (05) | MO |
225304001 | (05) | AR |
Q030756 | (05) | TN |