Basic Information
| Provider Information | |||||||||
| NPI: | 1285931758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMILTON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WESLEY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 CLOVERDALE RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356331302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562847706 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3500 CLOVERDALE RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356331302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562847706 | ||||||||
| FaxNumber: | 2562847711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2011 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 1-097111 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | 1-097111 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 241184 | 05 | AL | MEDICAID | 1523184 | 05 | TN | MEDICAID |