Provider Demographics
NPI:1700865110
Name:HAMILL, RANDY L (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:L
Last Name:HAMILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-4631
Mailing Address - Fax:706-787-4632
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-4631
Practice Address - Fax:706-787-4632
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036168207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52140518OtherBCBS
GA338033OtherWELLCARE
GA588983363AMedicaid
GA10058442OtherAMERIGROUP
GA581446543OtherTRICARE
GAG36168Medicaid
GAI08870Medicare UPIN
GA52140518OtherBCBS
GAP00144149Medicare ID - Type UnspecifiedRR MEDICARE