MEDICARE: MR. RUDY GARY HAMM PA-C

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	363AM0700X	Medical Physician Assistant	PA0000000203TN	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1649270844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUDY GARY HAMM PA-C

Provider Business Mailing Address
First Line	:	1559 HIGHLAND PARK DR
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6237
Country	:	US
Telephone Number	:	865-635-8389
Fax Number	:	656-358-3908

Provider Business Practice Location Address
First Line	:	1559 HIGHLAND PARK DR
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6237
Country	:	US
Telephone Number	:	865-635-8389
Fax Number	:	865-635-8390

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	04/25/2020

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