Provider Demographics
NPI:1043731268
Name:STOCKTON, HAMILTON IV (ATC)
Entity Type:Individual
Prefix:MR
First Name:HAMILTON
Middle Name:
Last Name:STOCKTON
Suffix:IV
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 DUDLEY LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3306
Mailing Address - Country:US
Mailing Address - Phone:404-791-7695
Mailing Address - Fax:
Practice Address - Street 1:1605 REILLY RD UNIT 71213
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28307-4953
Practice Address - Country:US
Practice Address - Phone:404-791-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT390200000X
GAAT0034232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000032997OtherBOARD OF CERTIFICATION