Basic Information
Provider Information
NPI: 1881677334
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: VAN
MiddleName: ERIC
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 677 CHURCH ST NE
Address2:  
City: MARIETTA
State: GA
PostalCode: 300601101
CountryCode: US
TelephoneNumber: 7707937750
FaxNumber: 7707937755
Practice Location
Address1: 677 CHURCH ST NE
Address2:  
City: MARIETTA
State: GA
PostalCode: 300601101
CountryCode: US
TelephoneNumber: 7707937750
FaxNumber: 7707937755
Other Information
ProviderEnumerationDate: 11/29/2005
LastUpdateDate: 01/20/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X033109GAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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