NPIMap

Organization Active NPI

Hamilton Mill Family Complete Care, LLC

  • Internal Medicine Physician
  • Dacula, GA
National Provider Identifier
1073881405
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
HAMILTON MILL FAMILY COMPLETE CARE, LLC
Practice address
3509 Braselton Hwy
Building F
Dacula, GA 30019-1107
Phone
(770) 614-6630
Fax
(770) 614-6684
NPI assigned
Dec 13, 2011
Last updated
Dec 13, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
COVENANT MEDICAL CENTER, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Russell GlassmanNPI 1174642631
Title
Member/Manager
Phone
(770) 614-6630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 176596 GA
Chiropractor 111N00000X 07581 GA
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

3509 Braselton Hwy
Building F
Dacula, GA 30019-1107

Mailing address

3509 Braselton Hwy
Building F
Dacula, GA 30019-1107
Phone (770) 614-6630

National Provider Directory

National Provider Directory
Tax ID family
Hamilton Mill Family Complete Care2 organizations share this tax ID, including this one
Part of
Covenant Medical Center

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1073881405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 BRASELTON HWY",
            "address_2": "BUILDING F",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191107",
            "telephone_number": "770-614-6630",
            "fax_number": "770-614-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 BRASELTON HWY",
            "address_2": "BUILDING F",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300191107",
            "telephone_number": "770-614-6630",
            "fax_number": "770-614-6684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMILTON MILL FAMILY COMPLETE CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT MEDICAL CENTER, P.C.",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "GLASSMAN",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "770-614-6630",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "176596",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "07581",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dacula, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.