Provider Demographics
NPI:1538153192
Name:HAMILTON, EDDIE D (MD)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:D
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 STONECREST PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6826
Mailing Address - Country:US
Mailing Address - Phone:615-625-7112
Mailing Address - Fax:615-625-7028
Practice Address - Street 1:343 FRANKLIN RD
Practice Address - Street 2:STE 210
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5213
Practice Address - Country:US
Practice Address - Phone:615-373-2248
Practice Address - Fax:615-373-5116
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN19089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3034011Medicaid
E06309Medicare UPIN
TN3034011Medicaid