Provider Demographics
NPI:1316435761
Name:HAMMER, GARRY WAYNE
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:WAYNE
Last Name:HAMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2230
Mailing Address - Country:US
Mailing Address - Phone:270-843-3192
Mailing Address - Fax:270-782-6672
Practice Address - Street 1:829 STATE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2230
Practice Address - Country:US
Practice Address - Phone:270-843-3192
Practice Address - Fax:270-782-6672
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY101860237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty