Provider Demographics
NPI:1639274350
Name:HAMILTON, WILLIAM VAN (DO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:VAN
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-482-1002
Mailing Address - Fax:601-482-1190
Practice Address - Street 1:1221 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-482-1002
Practice Address - Fax:601-482-1190
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120620Medicaid
C51835Medicare UPIN
MS160000535Medicare ID - Type Unspecified