Healthcare Provider Details

I. General information

NPI: 1720038037
Provider Name (Legal Business Name): ERIC BRADLEY HAMMETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 S 1ST ST
JESUP GA
31545-0210
US

IV. Provider business mailing address

PO BOX 410
JESUP GA
31598-0410
US

V. Phone/Fax

Practice location:
  • Phone: 912-427-6811
  • Fax:
Mailing address:
  • Phone: 800-749-2940
  • Fax: 888-820-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN158200
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: