MEDICARE: BECKY LASHONE HAMILTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	685167398	FL
2	171W00000X	Contractor	685167396	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720382344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY LASHONE HAMILTON

Provider Business Mailing Address
First Line	:	4446 HENDRICKS AVE
Second Line	:	260
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6369
Country	:	US
Telephone Number	:	904-962-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	4446 HENDRICKS AVE
Second Line	:	260
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6369
Country	:	US
Telephone Number	:	904-962-1860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	12/23/2010

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