Provider Demographics
NPI:1093723017
Name:HAMILTON, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 WEST COLLEGE ST
Mailing Address - Street 2:INFANTS AND CHILDRENS CLINIC PC
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-764-0670
Mailing Address - Fax:256-764-1139
Practice Address - Street 1:421 WEST COLLEGE ST
Practice Address - Street 2:INFANTS AND CHILDRENS CLINIC PC
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-764-0670
Practice Address - Fax:256-764-1139
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13098208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51081526OtherBC
AL000081526Medicaid
AL000081526Medicaid