MEDICARE: MR. JAMES ANDREW HAMILTON III

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	103TR0400X	Rehabilitation Psychologist	007657406	LA

General Provider Information

NPI Number	:	1497307615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ANDREW HAMILTON III

Provider Business Mailing Address
First Line	:	3830 VERRET ST
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-4534
Country	:	US
Telephone Number	:	504-905-8365
Fax Number	:	504-682-3034

Provider Business Practice Location Address
First Line	:	3830 VERRET ST
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-4534
Country	:	US
Telephone Number	:	504-905-8365
Fax Number	:	504-682-3034

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	07/09/2019

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