Healthcare Provider Details

I. General information

NPI: 1710611660
Provider Name (Legal Business Name): RACHEL HAMILTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 COUNTRY CLUB RD
WINSTON SALEM NC
27104-3509
US

IV. Provider business mailing address

3323 NOTTINGHAM RD
WINSTON SALEM NC
27104-1840
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2261
  • Fax:
Mailing address:
  • Phone: 608-574-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY1688
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: