Provider Demographics
NPI:1588433916
Name:HAMMOCK, ERICA (RN)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HAMMOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:HUMPHRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6978 S ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:LIZELLA
Mailing Address - State:GA
Mailing Address - Zip Code:31052-5700
Mailing Address - Country:US
Mailing Address - Phone:706-508-3107
Mailing Address - Fax:
Practice Address - Street 1:6978 S ROGERS RD
Practice Address - Street 2:
Practice Address - City:LIZELLA
Practice Address - State:GA
Practice Address - Zip Code:31052-5700
Practice Address - Country:US
Practice Address - Phone:706-508-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN106867163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management