Provider Demographics
NPI:1508384496
Name:HAMILTON, AUSTIN DESHON (MA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DESHON
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5137
Mailing Address - Country:US
Mailing Address - Phone:302-450-6952
Mailing Address - Fax:
Practice Address - Street 1:501 20TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-6900
Practice Address - Country:US
Practice Address - Phone:970-351-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program