Provider Demographics
NPI:1154392553
Name:HAMMOND, MARILYN SMITH (MS)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:SMITH
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LYN
Other - Middle Name:SMITH
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:POB 250567
Mailing Address - Street 2:ROOM 395 135 RUTLEDGE AVE
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-876-1504
Mailing Address - Fax:843-876-1518
Practice Address - Street 1:135 RUTLEDGE AVE
Practice Address - Street 2:POB 250567 ROOM 395
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:843-876-1504
Practice Address - Fax:843-876-1518
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93061170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
93061OtherAMERICAN BOARD OF GENETIC