Provider Demographics
NPI:1104803832
Name:HAMAKER, RICHARD F (PA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:HAMAKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-0307
Mailing Address - Country:US
Mailing Address - Phone:770-887-1668
Mailing Address - Fax:770-781-9937
Practice Address - Street 1:220 OAKSIDE LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6413
Practice Address - Country:US
Practice Address - Phone:678-807-1050
Practice Address - Fax:678-807-1055
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004567363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004567OtherGA PHYS ASSISTANT LIC #
GA004567OtherGA PHYS ASSISTANT LIC #