Provider Demographics
NPI:1386272904
Name:GREENHILL, COLIN (PA)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:GREENHILL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 DEL PASO RD STE 250
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-9667
Mailing Address - Country:US
Mailing Address - Phone:916-441-0400
Mailing Address - Fax:916-441-0406
Practice Address - Street 1:2700 CLAIRMONT RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2713
Practice Address - Country:US
Practice Address - Phone:470-816-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11396363A00000X
CA1386272904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant