Healthcare Provider Details

I. General information

NPI: 1629720628
Provider Name (Legal Business Name): JENNIFER HILL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 VETERANS PKWY S
MOULTRIE GA
31788-6705
US

IV. Provider business mailing address

2720 JACQUELINE CIR
MOULTRIE GA
31768-6744
US

V. Phone/Fax

Practice location:
  • Phone: 229-985-4815
  • Fax:
Mailing address:
  • Phone: 229-921-3920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN264139
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: