MEDICARE: DR. SCOTT L. HAMBLETON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	20010	MS

General Provider Information

NPI Number	:	1003955626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT L. HAMBLETON M.D.

Provider Business Mailing Address
First Line	:	7048 OLD CANTON RD STE 2001
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-1021
Country	:	US
Telephone Number	:	601-850-9220
Fax Number	:	866-629-9591

Provider Business Practice Location Address
First Line	:	7048 OLD CANTON ROAD
Second Line	:	SUITE 2001
City	:	RIDGELAND
State	:	MS
Zip	:	39157
Country	:	US
Telephone Number	:	601-850-9220
Fax Number	:	601-255-2606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/29/2025

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