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General NPI Number Information
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NPI Number | 1972651727
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Entity Type | Individual
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Provider Name | ALVIN RAY HAMILTON JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1970 HOSPITAL DR
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City | CLARKSDALE
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State | MS
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Zip | 38614-7202
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Country | US
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Telephone | 662-624-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PICADILLY DR
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City | BATESVILLE
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State | MS
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Zip | 38606-2100
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Country | US
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Telephone | 662-563-9968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R874579
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License Number State | MS
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