1750465225 NPI number — MRS. STACY HALL HILL OTR/L

Table of content: MRS. STACY HALL HILL OTR/L (NPI 1750465225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750465225 NPI number — MRS. STACY HALL HILL OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
STACY
Provider Middle Name:
HALL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750465225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
347 ARNOLD MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-2835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-354-6664
Provider Business Mailing Address Fax Number:
678-868-2181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 JEP WHEELER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-923-1087
Provider Business Practice Location Address Fax Number:
678-868-2181
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  OT003319 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 527686617-002 . This is a "BCBS OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com