Basic Information
Provider Information
NPI: 1699205203
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: JASON
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 INDEPENDENCE PT STE 212
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296154536
CountryCode: US
TelephoneNumber: 8647976306
FaxNumber:  
Practice Location
Address1: 890 WEST FARIS ROAD
Address2: SUITE 470
City: GREENVILLE
State: SC
PostalCode: 29605
CountryCode: US
TelephoneNumber: 8644557887
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/15/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X40725SCY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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