Provider Demographics
NPI:1528782547
Name:HILL, CORETTA LAUREEN
Entity type:Individual
Prefix:MRS
First Name:CORETTA
Middle Name:LAUREEN
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391544
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-0026
Mailing Address - Country:US
Mailing Address - Phone:404-587-3315
Mailing Address - Fax:
Practice Address - Street 1:3619 SWEET IRIS CIR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3778
Practice Address - Country:US
Practice Address - Phone:404-587-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty