Healthcare Provider Details

I. General information

NPI: 1851390249
Provider Name (Legal Business Name): CONSTANCE ANNE HAMILTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MISS CONSTANCE ANNE BORGFORD

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 HARMON AVE SUITE 2J11B
FORT STEWART GA
31314-5611
US

IV. Provider business mailing address

428 MARTIN RD MARTIN WOODS
HINESVILLE GA
31313-5524
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-0625
  • Fax:
Mailing address:
  • Phone: 912-369-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number096598
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1051142
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: