Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1-140359 | AL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1-140359 | AL |
NPI | 1063955540 |
---|---|
Provider Name | Mrs. Johanna Marie Hamilton |
First Address | Columbus, MS 39705 |
Second Address | Columbus, MS 39705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2016 |
Last Update Date | 03/09/2021 |