Healthcare Provider Details

I. General information

NPI: 1457309544
Provider Name (Legal Business Name): CHARLES E. HILL M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE ROOM F147A
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1364 CLIFTON RD NE ROOM F147A
ATLANTA GA
30322-1059
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-4615
  • Fax: 404-712-5567
Mailing address:
  • Phone: 404-712-4615
  • Fax: 404-712-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number047766
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number047766
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: