Healthcare Provider Details

I. General information

NPI: 1639396393
Provider Name (Legal Business Name): STEPHEN C HAMMACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/12/2023
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 E LAYFAIR DR
FLOWOOD MS
39232-9526
US

IV. Provider business mailing address

PO BOX 23996
JACKSON MS
39225
US

V. Phone/Fax

Practice location:
  • Phone: 601-414-6520
  • Fax:
Mailing address:
  • Phone: 601-206-6100
  • Fax: 601-206-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19226
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: