Provider Demographics
NPI:1104313881
Name:HAMILTON, TRACY (CCSH/RRT-SDS/RPSGT/R)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CCSH/RRT-SDS/RPSGT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-6501
Mailing Address - Country:US
Mailing Address - Phone:662-377-3258
Mailing Address - Fax:662-377-2212
Practice Address - Street 1:1845 S GREEN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6501
Practice Address - Country:US
Practice Address - Phone:662-377-3258
Practice Address - Fax:662-377-2212
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6654225500000X
MS5436225500000X
MSRCP1694227800000X, 227900000X
MS622174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered