Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DS040471 | PA |
N | 213EG0000X | General Practice | DS040471 | PA |
Y | 1223P0300X | Periodontist | DS040471 | PA |
NPI | 1134595804 |
---|---|
Provider Name | Richard Bardwell Hill |
First Address | Augusta, GA 30907-1479 |
Second Address | Ft Wainwright, AK 99703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2015 |
Last Update Date | 26/07/2019 |