MEDICARE: DR. ENOCH MATISON HAMMON JR. D. D. S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	01872	TN

General Provider Information

NPI Number	:	1679684005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENOCH MATISON HAMMON JR. D. D. S.

Provider Business Mailing Address
First Line	:	1101 LOWER MILL RD
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-2908
Country	:	US
Telephone Number	:	423-842-2723
Fax Number	:

Provider Business Practice Location Address
First Line	:	4841 HIXSON PIKE STE E
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4431
Country	:	US
Telephone Number	:	423-877-5242
Fax Number	:	423-877-5261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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