MEDICARE: MR. REGINALD ROYSTON HAMILTON

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	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1225893126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REGINALD ROYSTON HAMILTON

Provider Business Mailing Address
First Line	:	1868 KNOLLRIDGE CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2024
Country	:	US
Telephone Number	:	614-309-2057
Fax Number	:

Provider Business Practice Location Address
First Line	:	1868 KNOLLRIDGE CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2024
Country	:	US
Telephone Number	:	614-309-2057
Fax Number	:

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

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

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Directions to “ MR. REGINALD ROYSTON HAMILTON ” Practice Location

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