Provider Demographics
NPI:1851194120
Name:HAMM, JERMAINE K I
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:K
Last Name:HAMM
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3804
Mailing Address - Country:US
Mailing Address - Phone:216-513-3172
Mailing Address - Fax:
Practice Address - Street 1:4611 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3804
Practice Address - Country:US
Practice Address - Phone:216-513-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTK094630172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver