Healthcare Provider Details

I. General information

NPI: 1003385733
Provider Name (Legal Business Name): JAMES G HAMILTON JR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4898 HIGHWAY 197
MOUNT AIRY GA
30563-2442
US

IV. Provider business mailing address

PO BOX 1615
CLARKESVILLE GA
30523-0027
US

V. Phone/Fax

Practice location:
  • Phone: 706-499-7290
  • Fax: 706-754-0160
Mailing address:
  • Phone: 706-754-7485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES GREGORY HAMILTON JR.
Title or Position: OWNER/EMPLOYEE
Credential: MD
Phone: 706-754-7485