Provider Demographics
NPI:1710319124
Name:HAMILTON, AMY S (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 PIEDMONT RD NE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2513
Mailing Address - Country:US
Mailing Address - Phone:404-842-0990
Mailing Address - Fax:
Practice Address - Street 1:3108 PIEDMONT RD NE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2513
Practice Address - Country:US
Practice Address - Phone:404-842-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist