Healthcare Provider Details

I. General information

NPI: 1891785101
Provider Name (Legal Business Name): ROGER E HILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 TOWER RD NE
MARIETTA GA
30060-6977
US

IV. Provider business mailing address

1810 WHITE CIR STE 105
MARIETTA GA
30066-5836
US

V. Phone/Fax

Practice location:
  • Phone: 770-423-0895
  • Fax: 770-429-8628
Mailing address:
  • Phone: 678-797-6820
  • Fax: 770-424-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number028277
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: