Healthcare Provider Details

I. General information

NPI: 1376509695
Provider Name (Legal Business Name): AMIR HAMMAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 CLEVELAND AVE PATHOLOGY DEPT
EAST POINT GA
30344
US

IV. Provider business mailing address

PO BOX 491240
LAWRENCEVILLE GA
30049
US

V. Phone/Fax

Practice location:
  • Phone: 404-466-1416
  • Fax: 404-466-1454
Mailing address:
  • Phone: 404-466-1416
  • Fax: 404-466-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number27727
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number27727
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: