Healthcare Provider Details

I. General information

NPI: 1104902998
Provider Name (Legal Business Name): EPHRIAM PAUL HAMM RPT, ECS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 STANDING BOY RD
COLUMBUS GA
31904-2219
US

IV. Provider business mailing address

6555 STANDING BOY RD
COLUMBUS GA
31904-2219
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-0161
  • Fax: 706-653-7453
Mailing address:
  • Phone: 706-653-0161
  • Fax: 706-653-7453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPT000495
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT000495
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: