Provider Demographics
NPI:1134272131
Name:DEBORAH HAMMOND-WICKFALL, M.D., P.C.
Entity type:Organization
Organization Name:DEBORAH HAMMOND-WICKFALL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAMMOND-WICKFALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-265-6322
Mailing Address - Street 1:PO BOX 54454
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-0454
Mailing Address - Country:US
Mailing Address - Phone:404-265-6322
Mailing Address - Fax:404-265-6321
Practice Address - Street 1:315 BOULEVARD NE
Practice Address - Street 2:SUITE 520
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1200
Practice Address - Country:US
Practice Address - Phone:404-265-6322
Practice Address - Fax:404-265-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADC3236OtherRR MEDICARE GROUP NO.
GAP00161487OtherRR MEDICARE PIN
GADC3236OtherRR MEDICARE GROUP NO.
GAP00161487OtherRR MEDICARE PIN
GA11SCCZQMedicare PIN