Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1-164421 | AL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | CNP181263 | ME |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN227394 | GA |
NPI | 1003346909 |
---|---|
Provider Name | Mrs. Tara Leeann Hamilton |
First Address | Byron, GA 31008-5663 |
Second Address | Byron, GA 31008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 27/08/2021 |