Provider Demographics
NPI:1124087077
Name:HAMIL, RACHEL W (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:W
Last Name:HAMIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 ATLANTA HWY STE A
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2212
Mailing Address - Country:US
Mailing Address - Phone:706-389-3065
Mailing Address - Fax:
Practice Address - Street 1:4017 ATLANTA HWY STE A
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2212
Practice Address - Country:US
Practice Address - Phone:706-389-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235425207P00000X
GA0474412083P0011X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003119527AMedicaid
WV3810001228Medicaid
VA010127360Medicaid
GA003119527AMedicaid
WV3810001228Medicaid
GA202I933064Medicare PIN
VA006090W68Medicare ID - Type Unspecified