Individual
BENITA NANNETTE HAMILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 NATHAN DEAN BLVD STE 105, DALLAS, GA 30157-4911
(470) 624-6792
(470) 202-1026
Mailing address
4764 SPRUCE WAY SW, SOUTH FULTON, GA 30331-7540
(845) 551-4229
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
005769-1
NY
363A00000X
Physician Assistant
Primary
12130
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355931
—
NY
Enumeration date
09/27/2006
Last updated
09/25/2024
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