Provider Demographics
NPI:1194946244
Name:HAMILTON, TANISHA JAMARRIA (MD)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:JAMARRIA
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1905
Mailing Address - Country:US
Mailing Address - Phone:214-821-1177
Mailing Address - Fax:
Practice Address - Street 1:3600 GASTON AVE STE 550
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1905
Practice Address - Country:US
Practice Address - Phone:214-821-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45274207R00000X
TXP0401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520821Medicaid
TX285065302Medicaid
TX285065304Medicaid
TX285065301Medicaid
TX285065303Medicaid
TX285065303Medicaid
TXTXB136172Medicare PIN
TXP00982783Medicare PIN
TXTXB154847Medicare PIN
TX285065304Medicaid
TX285065301Medicaid
TN103I113962Medicare PIN