Healthcare Provider Details

I. General information

NPI: 1154749943
Provider Name (Legal Business Name): JONATHAN HILL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 JENNINGS MILL RD STE 110
WATKINSVILLE GA
30677-7241
US

IV. Provider business mailing address

1305 JENNINGS MILL RD STE 110
WATKINSVILLE GA
30677-7241
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-5880
  • Fax:
Mailing address:
  • Phone: 706-613-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000009312
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10914
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: