Healthcare Provider Details

I. General information

NPI: 1699397810
Provider Name (Legal Business Name): JERAD BRYAN HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 MALL RD
FLORENCE AL
35630-2809
US

IV. Provider business mailing address

2465 MALL RD
FLORENCE AL
35630-2809
US

V. Phone/Fax

Practice location:
  • Phone: 256-764-4242
  • Fax: 256-764-4343
Mailing address:
  • Phone: 256-764-4242
  • Fax: 256-764-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number933
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: