Healthcare Provider Details

I. General information

NPI: 1245399062
Provider Name (Legal Business Name): DONNA M HAMMONTREE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 HODGSON MEMORIAL DR STE 103
SAVANNAH GA
31406-1517
US

IV. Provider business mailing address

7002 HODGSON MEMORIAL DR STE 103
SAVANNAH GA
31406-1517
US

V. Phone/Fax

Practice location:
  • Phone: 912-234-2159
  • Fax: 912-691-5151
Mailing address:
  • Phone: 912-234-2159
  • Fax: 912-691-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002734
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00941256A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier277701000
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerMAGELLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: