Provider Demographics
NPI:1285779710
Name:MARK R. HILL
Entity type:Organization
Organization Name:MARK R. HILL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-757-3019
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:NICHOLSON
Mailing Address - State:GA
Mailing Address - Zip Code:30565-0430
Mailing Address - Country:US
Mailing Address - Phone:706-757-3019
Mailing Address - Fax:706-757-3019
Practice Address - Street 1:4878 HWY 441 S
Practice Address - Street 2:
Practice Address - City:NICHOLSON
Practice Address - State:GA
Practice Address - Zip Code:30565-0430
Practice Address - Country:US
Practice Address - Phone:706-757-3019
Practice Address - Fax:706-757-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00697859AMedicaid
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