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Individual
MR. JERRY HAMILTON
Active
Individual
MR. JERRY HAMILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
1502
AR
1041C0700X
Clinical Social Worker
Primary
3165
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11549639
CAQH AETNA
TN
05
—
3699016
—
TN
01
—
4114450
BLUE CROSS BLUE SHIELD
TN
01
—
568759-000
MAGELLAN HEALTH CARE
TN
Enumeration date
09/25/2007
Last updated
05/09/2012
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