Provider Demographics
NPI:1871994327
Name:HAMMETT, JO LINDA
Entity type:Individual
Prefix:
First Name:JO
Middle Name:LINDA
Last Name:HAMMETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JO
Other - Middle Name:LINDA
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE, INC., DBA AGAPE PHYSICIANS C
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-454-0365
Mailing Address - Fax:803-404-6000
Practice Address - Street 1:529 MILLS AVENUE
Practice Address - Street 2:AGAPE PHYSICIANS CARE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605
Practice Address - Country:US
Practice Address - Phone:843-751-6430
Practice Address - Fax:864-751-6424
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2930Medicaid