Healthcare Provider Details

I. General information

NPI: 1578598140
Provider Name (Legal Business Name): MYRNA HAMMOND CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYRNA BARTON (MAIDEN)

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 BIG A RD
TOCCOA GA
30577-6002
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-8419
  • Fax: 706-827-5083
Mailing address:
  • Phone: 770-219-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN079839
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN079839
License Number StateGA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: