Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 61442724286 | GA |
Y | 213ES0000X | Sports Medicine | 61442724286 | GA |
NPI | 1447872700 |
---|---|
Provider Name | Shaq S Hill-Lofton |
First Address | Stone Mountain, GA 30087-6068 |
Second Address | Stone Mountain, GA 30087-6068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2020 |
Last Update Date | 10/05/2020 |