Individual
MR. JERRY HAMILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
7165 GETWELL RD, SOUTHAVEN, MS 38672-9618
(662) 349-2818
(662) 342-3406
Mailing address
7165 GETWELL DRIVE, SOUTHAVEN, MS 38109-1722
(901) 345-0636
(662) 772-3259
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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