Provider Demographics
NPI:1801837083
Name:HAMILTON, MARIANGELI M (NP)
Entity Type:Individual
Prefix:
First Name:MARIANGELI
Middle Name:M
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:ATTN: HOPE VILLARRUEL-SAMS
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:210 E. DERENNE AVENUE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:81405
Practice Address - Country:US
Practice Address - Phone:912-644-5300
Practice Address - Fax:912-644-5260
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9243519363LF0000X
GARN089362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3078507-00Medicaid
GA513433490HMedicaid
GA513433490AMedicaid
FL3078507-00Medicaid
FLP00957248Medicare PIN
GA513433490HMedicaid
FLAB834ZMedicare PIN
FLQ77356Medicare UPIN