Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN291707 | GA |
NPI | 1275164436 |
---|---|
Provider Name | Jordan Tyler Hill |
First Address | Atlanta, GA 30309-4379 |
Second Address | Atlanta, GA 30308-2212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2020 |
Last Update Date | 27/01/2020 |