Healthcare Provider Details

I. General information

NPI: 1063467140
Provider Name (Legal Business Name): JOHN EDWARD HILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 S GREEN ST
TUPELO MS
38804-6556
US

IV. Provider business mailing address

450 E PRESIDENT AVE
TUPELO MS
38801-5599
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-2189
  • Fax: 662-377-2263
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04987
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: