=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104902998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EPHRIAM PAUL HAMM RPT, ECS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 02/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6555 STANDING BOY RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-653-0161
-----------------------------------------------------
Fax | 706-653-7453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6555 STANDING BOY RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-653-0161
-----------------------------------------------------
Fax | 706-653-7453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171000000X
-----------------------------------------------------
Taxonomy Name | Military Health Care Provider
-----------------------------------------------------
License Number | PT000495
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251E1300X
-----------------------------------------------------
Taxonomy Name | Clinical Electrophysiology Physical Therapist
-----------------------------------------------------
License Number | PT000495
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------