Provider Demographics
NPI:1992701965
Name:HILL, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-8090
Mailing Address - Country:US
Mailing Address - Phone:901-252-6034
Mailing Address - Fax:901-252-6048
Practice Address - Street 1:2860 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-8090
Practice Address - Country:US
Practice Address - Phone:901-252-6034
Practice Address - Fax:901-252-6048
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0006575174400000X
TNMD0065752080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3155497Medicaid
TN3155497Medicaid
TN3025734Medicare ID - Type Unspecified