Provider Demographics
NPI:1518027457
Name:ANDERSON, MARY HAMILTON (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:HAMILTON
Last Name:ANDERSON
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:P.O BOX 1758
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3089
Mailing Address - Country:US
Mailing Address - Phone:706-854-2500
Mailing Address - Fax:706-854-2559
Practice Address - Street 1:411 TOWN BLVD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3089
Practice Address - Country:US
Practice Address - Phone:706-854-2500
Practice Address - Fax:706-854-2559
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031554207K00000X, 2080P0201X
GA315542080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000555981BMedicaid
GA000555981CMedicaid
GA000555981CMedicaid