Healthcare Provider Details

I. General information

NPI: 1164705570
Provider Name (Legal Business Name): HILLARY N NCHOTU PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAKE HEARN DR NE SUITE #425
ATLANTA GA
30319-1415
US

IV. Provider business mailing address

301 LAKE KNOLL DR NW
LILBURN GA
30047-8704
US

V. Phone/Fax

Practice location:
  • Phone: 404-497-9837
  • Fax: 404-497-9839
Mailing address:
  • Phone: 678-524-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026125
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209315
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: