Healthcare Provider Details

I. General information

NPI: 1316324221
Provider Name (Legal Business Name): HAMILTON MILL HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 HWY 317 SUITE 12-318
SUWANEE GA
30024-2649
US

IV. Provider business mailing address

2085 HAMILTON CREEK PARKWAY SUITE 106
DACULA GA
30019-5402
US

V. Phone/Fax

Practice location:
  • Phone: 678-546-8044
  • Fax: 678-546-8047
Mailing address:
  • Phone: 678-546-8044
  • Fax: 678-546-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MONICA SHELTON
Title or Position: OPERATION MANAGER
Credential:
Phone: 678-730-6240