Provider Demographics
NPI:1053503417
Name:HILL, JORDAN LYNN (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LYNN
Last Name:HILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-901-0800
Mailing Address - Fax:757-578-8547
Practice Address - Street 1:13892 TIMBER WAY
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-3332
Practice Address - Country:US
Practice Address - Phone:540-901-0800
Practice Address - Fax:757-578-8547
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053503417Medicaid