Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIR009713 | GA |
NPI | 1164048245 |
---|---|
Provider Name | Antonio Hill |
First Address | Lawrenceville, GA 30043-4100 |
Second Address | Lawrenceville, GA 30043-4100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2020 |
Last Update Date | 24/06/2020 |