Healthcare Provider Details

I. General information

NPI: 1619571437
Provider Name (Legal Business Name): BRANDI HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BENJAMIN H. HILL DRIVE SW
FITZGERALD GA
31750
US

IV. Provider business mailing address

1500 1ST AVE N UNIT 3
BIRMINGHAM AL
35203-1866
US

V. Phone/Fax

Practice location:
  • Phone: 229-635-4004
  • Fax:
Mailing address:
  • Phone: 205-545-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN215948
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: