Provider Demographics
NPI:1588652739
Name:HAMILTON MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:HAMILTON MEDICAL CENTER, INC
Other - Org Name:HAMILTON MEDICAL CENTER HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-272-6000
Mailing Address - Street 1:PO BOX 1168
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1168
Mailing Address - Country:US
Mailing Address - Phone:706-278-2848
Mailing Address - Fax:706-217-1008
Practice Address - Street 1:1209 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2530
Practice Address - Country:US
Practice Address - Phone:706-278-2848
Practice Address - Fax:706-217-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA155-088H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00380256AMedicaid
GA11-1500Medicare ID - Type Unspecified
GA00380256AMedicaid