Basic Information
| Provider Information | |||||||||
| NPI: | 1528056066 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMILTON MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1168 | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307221168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062726000 | ||||||||
| FaxNumber: | 7062726117 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307202529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062726000 | ||||||||
| FaxNumber: | 7062726117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | HARBUCK | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7062726000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | 3336L0003X | N | Suppliers | Pharmacy | Long Term Care Pharmacy | 282N00000X | 155-527 | GA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0110001 | 05 | TN | MEDICAID | 100013 | 01 | GA | BCBS OF GEORGIA | OTHER | 00000899A | 05 | GA | MEDICAID |