Healthcare Provider Details

I. General information

NPI: 1497011696
Provider Name (Legal Business Name): DUSTIN NICOLAS HILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DR
CORINTH MS
38834-9321
US

IV. Provider business mailing address

39 COUNTY ROAD 617
CORINTH MS
38834-1130
US

V. Phone/Fax

Practice location:
  • Phone: 225-335-0475
  • Fax:
Mailing address:
  • Phone: 225-335-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23692
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5859
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME137031
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number71705
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: