Healthcare Provider Details

I. General information

NPI: 1558346932
Provider Name (Legal Business Name): PHILIP M HOTCHKISS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 SIXES RD STE 125A
HOLLY SPRINGS GA
30115-8758
US

IV. Provider business mailing address

697 LOUISIANA RD
DYESS AFB TX
79607-1141
US

V. Phone/Fax

Practice location:
  • Phone: 678-426-5450
  • Fax: 678-426-5454
Mailing address:
  • Phone: 325-696-4754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: