Provider Demographics
NPI:1659645950
Name:DR FLETCHER HAMILTON LLC
Entity Type:Organization
Organization Name:DR FLETCHER HAMILTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:FLETCHER
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-871-0031
Mailing Address - Street 1:1 INDEPENDENCE PLZ
Mailing Address - Street 2:SUITE 716
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2629
Mailing Address - Country:US
Mailing Address - Phone:205-871-0031
Mailing Address - Fax:205-803-1280
Practice Address - Street 1:1 INDEPENDENCE PLZ
Practice Address - Street 2:SUITE 716
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2629
Practice Address - Country:US
Practice Address - Phone:205-871-0031
Practice Address - Fax:205-803-1280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL278305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000070564OtherPTAN