Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 034159 | GA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 034159 | GA |
NPI | 1215098090 |
---|---|
Provider Name | Glenn Paul Hittel |
First Address | Rome, GA 30165-1369 |
Second Address | Cartersville, GA 30120-8522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 01/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000457564B | (05) | GA |
C82232 | (02) |