Basic Information
Provider Information
NPI: 1417311044
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILLHOUSE
FirstName: CHRISTOPHER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 17 DAVIS BLVD
Address2: SUITE 308
City: TAMPA
State: FL
PostalCode: 336063475
CountryCode: US
TelephoneNumber: 8132598725
FaxNumber:  
Practice Location
Address1: 80 JESSE HILL JR DR SE
Address2:  
City: ATLANTA
State: GA
PostalCode: 303033050
CountryCode: US
TelephoneNumber: 4047274145
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/10/2016
LastUpdateDate: 06/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X85643GAN Allopathic & Osteopathic PhysiciansPediatrics 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000X85643GAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home