Provider Demographics
NPI:1831240316
Name:HAMILTON, BRYN G (RD)
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:G
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 OBERLIN RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3434
Mailing Address - Country:US
Mailing Address - Phone:706-738-2602
Mailing Address - Fax:
Practice Address - Street 1:1500 JOHNS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4888
Practice Address - Country:US
Practice Address - Phone:706-481-7298
Practice Address - Fax:706-481-7971
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered