Healthcare Provider Details

I. General information

NPI: 1437425899
Provider Name (Legal Business Name): SHASHEETA YOULANDA HAMMOND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 GEORGIAN PL APT 5
DALTON GA
30720-4388
US

IV. Provider business mailing address

1300 GEORGIAN PL APT 5
DALTON GA
30720-4388
US

V. Phone/Fax

Practice location:
  • Phone: 762-209-1070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN211029
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: