Healthcare Provider Details

I. General information

NPI: 1205123296
Provider Name (Legal Business Name): JOSH A HAMMEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD STE 280
ROSWELL GA
30076-4918
US

IV. Provider business mailing address

2500 HOSPITAL BLVD STE 280
ROSWELL GA
30076-4918
US

V. Phone/Fax

Practice location:
  • Phone: 770-754-0787
  • Fax: 770-755-5890
Mailing address:
  • Phone: 770-754-0787
  • Fax: 770-755-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number082110
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number082110
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: