Provider Demographics
NPI:1629233614
Name:HAMILTON, SHIRLEY BROWN
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:BROWN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MARSHALL ST STE 52
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5858
Mailing Address - Country:US
Mailing Address - Phone:336-577-5904
Mailing Address - Fax:336-724-1194
Practice Address - Street 1:1001 S MARSHALL ST STE 52
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5858
Practice Address - Country:US
Practice Address - Phone:336-577-5904
Practice Address - Fax:336-724-1194
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418980Medicaid