Provider Demographics
NPI:1063213536
Name:HAMILTON, ANTHONY DUWAYNE
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DUWAYNE
Last Name:HAMILTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SPURLOCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25520-1162
Mailing Address - Country:US
Mailing Address - Phone:304-444-7450
Mailing Address - Fax:
Practice Address - Street 1:75 SPURLOCK CREEK RD
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:WV
Practice Address - Zip Code:25520-1162
Practice Address - Country:US
Practice Address - Phone:304-444-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF362191347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle