Healthcare Provider Details

I. General information

NPI: 1205149481
Provider Name (Legal Business Name): SCOTT BUTLER HAMILTON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 CLAIRMONT RD NE
ATLANTA GA
30329-3330
US

IV. Provider business mailing address

PO BOX 98172
ATLANTA GA
30359-1872
US

V. Phone/Fax

Practice location:
  • Phone: 317-989-9799
  • Fax:
Mailing address:
  • Phone: 317-989-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY003584
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003584
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: