1851390249 NPI number — MRS. CONSTANCE ANNE HAMILTON RN

Table of content: MRS. CONSTANCE ANNE HAMILTON RN (NPI 1851390249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851390249 NPI number — MRS. CONSTANCE ANNE HAMILTON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMILTON
Provider First Name:
CONSTANCE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORGFORD
Provider Other First Name:
CONSTANCE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851390249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428 MARTIN RD
Provider Second Line Business Mailing Address:
MARTIN WOODS
Provider Business Mailing Address City Name:
HINESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31313-5524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-369-5366
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 HARMON AVE
Provider Second Line Business Practice Location Address:
SUITE 2J11B
Provider Business Practice Location Address City Name:
FORT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-435-0625
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0200X , with the licence number:  096598 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WP0200X , with the licence number: 1051142 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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