=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346222742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES G HAMILTON JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2005
-----------------------------------------------------
Last Update Date | 12/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 676 HISTORIC HWY 441 N
-----------------------------------------------------
City | DEMOREST
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-499-7290
-----------------------------------------------------
Fax | 706-754-0160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1615
-----------------------------------------------------
City | CLARKESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30523-0027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-754-7485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 29179
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------