Provider Demographics
NPI:1982000162
Name:HAMAR, JULIE MALKOWSKI (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MALKOWSKI
Last Name:HAMAR
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANGELA
Other - Last Name:MALKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1616 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3191
Mailing Address - Country:US
Mailing Address - Phone:615-444-1180
Mailing Address - Fax:
Practice Address - Street 1:1616 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3191
Practice Address - Country:US
Practice Address - Phone:615-444-1180
Practice Address - Fax:615-449-0091
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant