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General NPI Number Information
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NPI Number | 1629403571
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Entity Type | Organization
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Legal Business Name | HAMILTON MILL FAMILY COMPLETE CARE
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 3515 BRASELTON HWY BLDG. E-2
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City | DACULA
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State | GA
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Zip | 30019
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Country | US
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Telephone | 770-614-6630
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Fax |
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Provider Business Mailing Address
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Address Line | 3515 BRASELTON HWY BLDG. E-2
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City | DACULA
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State | GA
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Zip | 30019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. RUSSELL GLASSMAN
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Credential | D.C.
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Telephone | 770-614-6630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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