Provider Demographics
NPI:1033214184
Name:HILL, MALCOLM (DC)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 HWY 138
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296
Mailing Address - Country:US
Mailing Address - Phone:678-954-7224
Mailing Address - Fax:678-954-7226
Practice Address - Street 1:1296 HWY 138
Practice Address - Street 2:SUITE 105
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296
Practice Address - Country:US
Practice Address - Phone:678-954-7224
Practice Address - Fax:678-954-7226
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA352CGTPOtherMEDICARE NUMBER
GA743235971OtherTAX ID
GA352CGTPOtherMEDICARE NUMBER