Healthcare Provider Details

I. General information

NPI: 1275164436
Provider Name (Legal Business Name): JORDAN TYLER HILL AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

60 11TH ST NE APT 1604
ATLANTA GA
30309-4379
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-7858
  • Fax:
Mailing address:
  • Phone: 615-720-3257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN291707
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: