Healthcare Provider Details

I. General information

NPI: 1568782142
Provider Name (Legal Business Name): NICHOLE CARLTON HILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 HAILE ST
CAMDEN SC
29020-3076
US

IV. Provider business mailing address

1803 MILL ST
CAMDEN SC
29020-2732
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-1931
  • Fax: 803-432-1176
Mailing address:
  • Phone: 843-737-3946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL32702
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: