Basic Information
| Provider Information | |||||||||
| NPI: | 1023448610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 276 NISSAN PKWY | ||||||||
| Address2: | BUILDING C SUITE 100 | ||||||||
| City: | CANTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390467006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018555275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 276 NISSAN PKWY | ||||||||
| Address2: | BUILDING C SUITE 100 | ||||||||
| City: | CANTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390467006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018555275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2013 | ||||||||
| LastUpdateDate: | 11/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | D1594 | MS | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.