1316324221 NPI number — HAMILTON MILL HEALTHCARE GROUP LLC

Table of content: (NPI 1316324221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316324221 NPI number — HAMILTON MILL HEALTHCARE GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON MILL HEALTHCARE GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316324221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2085 HAMILTON CREEK PARKWAY
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
DACULA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30019-5402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-546-8044
Provider Business Mailing Address Fax Number:
678-546-8047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2133 HWY 317
Provider Second Line Business Practice Location Address:
SUITE 12-318
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-546-8044
Provider Business Practice Location Address Fax Number:
678-546-8047
Provider Enumeration Date:
04/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHELTON
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATION MANAGER
Authorized Official Telephone Number:
678-730-6240

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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