Provider Demographics
NPI:1992323554
Name:HILLMON, MONTAKESHA RANGE
Entity type:Individual
Prefix:
First Name:MONTAKESHA
Middle Name:RANGE
Last Name:HILLMON
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 2831
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-2831
Mailing Address - Country:US
Mailing Address - Phone:229-567-4086
Mailing Address - Fax:
Practice Address - Street 1:1045 MARTIN LUTHER KING JR DR LOT 42
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-2146
Practice Address - Country:US
Practice Address - Phone:229-567-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor