Provider Demographics
NPI:1871051144
Name:HILL, ANGEL M
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:M
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 1:90 VILLA NOVA ST
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-6221
Mailing Address - Country:US
Mailing Address - Phone:229-366-0906
Mailing Address - Fax:229-732-6621
Practice Address - Street 1:90 VILLA NOVA ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-6221
Practice Address - Country:US
Practice Address - Phone:229-366-0906
Practice Address - Fax:229-732-6621
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator