=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992112718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELENE HAMER-MCGHEE REGISTERED NURSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2014
-----------------------------------------------------
Last Update Date | 07/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 E. HOSPITAL RD
-----------------------------------------------------
City | FORT GORDON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30905-5741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-787-3568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 EAST HOSPITAL ROAD
-----------------------------------------------------
City | FORT GORDON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30905-5741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-787-3568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN164833
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WA2000X
-----------------------------------------------------
Taxonomy Name | Administrator Registered Nurse
-----------------------------------------------------
License Number | RN164833
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Registered Nurse
-----------------------------------------------------
License Number | RN164833
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number | RN164833
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | RN164833
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------