Provider Demographics
NPI:1861417164
Name:HAMMOND, MARK L (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 383227
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-3227
Mailing Address - Country:US
Mailing Address - Phone:901-844-1431
Mailing Address - Fax:901-761-4145
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:#1052
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4701
Practice Address - Country:US
Practice Address - Phone:901-844-1431
Practice Address - Fax:901-761-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD15646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116351Medicaid
TN3010268Medicaid
TN4069880OtherBCBS
A97453Medicare UPIN
MS00116351Medicaid