Healthcare Provider Details

I. General information

NPI: 1770809394
Provider Name (Legal Business Name): REGINA FAY HAMMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N MAIN ST
DICKSON TN
37055-1802
US

IV. Provider business mailing address

224 N MAIN ST
DICKSON TN
37055-1802
US

V. Phone/Fax

Practice location:
  • Phone: 615-460-4430
  • Fax: 615-460-4433
Mailing address:
  • Phone: 615-460-4430
  • Fax: 615-460-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: