Provider Demographics
NPI:1811004807
Name:HAMILTON, JOHN WESLEY (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLEY
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 1:12449 N ANGELS GATE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3847
Mailing Address - Country:US
Mailing Address - Phone:423-505-2031
Mailing Address - Fax:
Practice Address - Street 1:975 E THIRD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-602-8400
Practice Address - Fax:423-602-8401
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1703207L00000X
UT12042620207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAN373513OtherWELLCARE(GA MEDICAID)
TN4109069OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TN3319460Medicaid
NC5902170Medicaid
GA738961264AMedicaid
AL009932404Medicaid
TNP00279136OtherMEDICARE RAILROAD
GA738961264AMedicaid
GA738961264AMedicaid
NC5902170Medicaid