Provider Demographics
NPI:1447891171
Name:ADMASSIE, HAMELMAL S
Entity type:Individual
Prefix:
First Name:HAMELMAL
Middle Name:S
Last Name:ADMASSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-0654
Mailing Address - Country:US
Mailing Address - Phone:773-782-0907
Mailing Address - Fax:
Practice Address - Street 1:880 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1532
Practice Address - Country:US
Practice Address - Phone:773-782-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000025070320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities