Provider Demographics
NPI:1174243612
Name:HAMILETT, DEONTAE JAMES
Entity type:Individual
Prefix:
First Name:DEONTAE
Middle Name:JAMES
Last Name:HAMILETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 TYLER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-3408
Mailing Address - Country:US
Mailing Address - Phone:304-444-2092
Mailing Address - Fax:
Practice Address - Street 1:103 TYLER RIDGE RD
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-3408
Practice Address - Country:US
Practice Address - Phone:304-444-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant