Provider Demographics
NPI:1104902998
Name:HAMM, EPHRIAM PAUL (RPT, ECS)
Entity type:Individual
Prefix:MR
First Name:EPHRIAM
Middle Name:PAUL
Last Name:HAMM
Suffix:
Gender:M
Credentials:RPT, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 STANDING BOY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2219
Mailing Address - Country:US
Mailing Address - Phone:706-653-0161
Mailing Address - Fax:706-653-7453
Practice Address - Street 1:6555 STANDING BOY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2219
Practice Address - Country:US
Practice Address - Phone:706-653-0161
Practice Address - Fax:706-653-7453
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT000495171000000X, 2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G707915OtherMEDICARE GROUP NUMBER FOR CDC ON COMER
GA003104321AMedicaid
GA202I652833Medicare PIN