Healthcare Provider Details

I. General information

NPI: 1013657600
Provider Name (Legal Business Name): KELLY LEWIS HAMILTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 VILCOM CENTER DR STE 300
CHAPEL HILL NC
27514-1875
US

IV. Provider business mailing address

77 VILCOM CENTER DR STE 300
CHAPEL HILL NC
27514-1875
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-9646
  • Fax: 984-974-5217
Mailing address:
  • Phone: 984-974-9646
  • Fax: 984-974-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2026-01986
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number2026-01986
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: