Provider Demographics
NPI:1770990012
Name:HAMILTON MILL MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:HAMILTON MILL MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/COO
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKENGESHAYI
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:TSHIMANGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:770-875-6578
Mailing Address - Street 1:4201 LANTERN HILL DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7231
Mailing Address - Country:US
Mailing Address - Phone:770-875-6578
Mailing Address - Fax:
Practice Address - Street 1:4201 LANTERN HILL DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7231
Practice Address - Country:US
Practice Address - Phone:770-875-6578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health