Healthcare Provider Details

I. General information

NPI: 1518425941
Provider Name (Legal Business Name): HAMM, BLACKSTOCK & STERN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 DALKEITH DR
GERMANTOWN TN
38139-3407
US

IV. Provider business mailing address

PO BOX 1000 DEPT #3032
MEMPHIS TN
38148-3032
US

V. Phone/Fax

Practice location:
  • Phone: 731-616-4099
  • Fax:
Mailing address:
  • Phone: 731-608-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL L SPENCER
Title or Position: VP OF OPERATIONS
Credential:
Phone: 731-608-0933