Provider Demographics
NPI:1225023104
Name:HAMATI, FAWWAZ I (MD)
Entity type:Individual
Prefix:
First Name:FAWWAZ
Middle Name:I
Last Name:HAMATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N STATE OF FRANKLIN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3645
Mailing Address - Country:US
Mailing Address - Phone:423-926-4468
Mailing Address - Fax:423-928-4838
Practice Address - Street 1:701 N STATE OF FRANKLIN RD STE 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3645
Practice Address - Country:US
Practice Address - Phone:423-926-4468
Practice Address - Fax:423-928-4838
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21253207R00000X, 207RI0011X
TNMD21253207RC0000X
VA0101220430207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060049771OtherRAIL ROAD MEDICARE
NC7906583Medicaid
TNP01368158OtherRAILROAD MEDICARE
TNTN0111OtherUNITED HEALTHCARE OF THE
VA1225023104Medicaid
TN3081427Medicaid
KY64927205Medicaid
TN3081422Medicaid
0020583100OtherBLACK LUNG
TN3094949OtherBLUE CROSS BLUE SHIELD
0004575129OtherAETNA
VA5824702Medicaid
VA5824702Medicaid
TNTN0111OtherUNITED HEALTHCARE OF THE
VA1225023104Medicaid
TN3081422Medicaid
TN621490616OtherTIN