Provider Demographics
NPI:1811410954
Name:HAMILTON, BRYNNA CHIVAUNE (NP-C)
Entity Type:Individual
Prefix:
First Name:BRYNNA
Middle Name:CHIVAUNE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 NEW HOME LOOP
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-5636
Mailing Address - Country:US
Mailing Address - Phone:423-718-9784
Mailing Address - Fax:
Practice Address - Street 1:980 HIGHWAY 28 STE 200
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3744
Practice Address - Country:US
Practice Address - Phone:423-942-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner