MEDICARE: MR. EPHRIAM PAUL HAMM RPT, ECS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider	PT000495	GA
2	2251E1300X	Clinical Electrophysiology Physical Therapist	PT000495	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202G707915	OTHER	GA	MEDICARE GROUP NUMBER FOR CDC ON COMER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104902998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EPHRIAM PAUL HAMM RPT, ECS

Provider Business Mailing Address
First Line	:	6555 STANDING BOY RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2219
Country	:	US
Telephone Number	:	706-653-0161
Fax Number	:	706-653-7453

Provider Business Practice Location Address
First Line	:	6555 STANDING BOY RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-2219
Country	:	US
Telephone Number	:	706-653-0161
Fax Number	:	706-653-7453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	02/28/2011

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Directions to “ MR. EPHRIAM PAUL HAMM RPT, ECS” Practice Location

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