Provider Demographics
NPI:1316033012
Name:HAMILTON, MARY RUTH (PA)
Entity Type:Individual
Prefix:
First Name:MARY RUTH
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 ITHACA ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-9516
Mailing Address - Country:US
Mailing Address - Phone:615-881-3916
Mailing Address - Fax:
Practice Address - Street 1:1135 ITHACA ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-9516
Practice Address - Country:US
Practice Address - Phone:615-881-3916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant