MEDICARE: MICHELLE HILLIARD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	103704	NC

General Provider Information

NPI Number	:	1679563548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HILLIARD PA-C

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 WESTCHESTER DR STE 101
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27262-7369
Country	:	US
Telephone Number	:	336-802-2105
Fax Number	:	336-802-2106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	05/15/2020

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