Provider Demographics
NPI:1164018099
Name:HILL, TAHIRA CHANNEL
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:CHANNEL
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 1:1155 E FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-3007
Mailing Address - Country:US
Mailing Address - Phone:678-775-9254
Mailing Address - Fax:
Practice Address - Street 1:1155 E FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-3007
Practice Address - Country:US
Practice Address - Phone:678-775-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician