Provider Demographics
NPI:1053397257
Name:HAMILTON WATERS, INC
Entity type:Organization
Organization Name:HAMILTON WATERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:912-635-2246
Mailing Address - Street 1:10 N BEACHVIEW DR
Mailing Address - Street 2:P.O. BOX 13088
Mailing Address - City:JEKYLL ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31527-0816
Mailing Address - Country:US
Mailing Address - Phone:912-635-2246
Mailing Address - Fax:912-635-2100
Practice Address - Street 1:10 N BEACHVIEW DR
Practice Address - Street 2:
Practice Address - City:JEKYLL ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31527-0816
Practice Address - Country:US
Practice Address - Phone:912-635-2246
Practice Address - Fax:912-635-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE005630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE005630OtherPHARMACY LIC #
GA1110989OtherNABP #
GA00136177AMedicaid
GA=========OtherTAX ID
GAPHRE005630OtherPHARMACY LIC #