Healthcare Provider Details

I. General information

NPI: 1124334545
Provider Name (Legal Business Name): MICHAEL CLARK HILTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 ROSWELL RD
ATLANTA GA
30342-4119
US

IV. Provider business mailing address

3975 ROSWELL RD
ATLANTA GA
30342-4119
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-4001
  • Fax:
Mailing address:
  • Phone: 404-352-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberG88174
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number33111
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: