Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN198373 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN198373 | GA |
NPI | 1083086136 |
---|---|
Provider Name | Shane Hill |
First Address | Macon, GA 31201-2102 |
Second Address | Macon, GA 31201-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 06/08/2020 |