Healthcare Provider Details

I. General information

NPI: 1710342589
Provider Name (Legal Business Name): LEANNA W HILTON APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 GREYSTONE WAY
VALDOSTA GA
31605-7421
US

IV. Provider business mailing address

3322 GREYSTONE WAY
VALDOSTA GA
31605-7421
US

V. Phone/Fax

Practice location:
  • Phone: 229-242-9310
  • Fax: 229-242-9714
Mailing address:
  • Phone: 229-242-9310
  • Fax: 229-242-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN214268
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN214268
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: