Provider Demographics
NPI:1114288701
Name:HILL, WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PROFESSIONAL CT SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-7020
Mailing Address - Country:US
Mailing Address - Phone:706-625-5900
Mailing Address - Fax:706-625-5906
Practice Address - Street 1:6405 OLD MAIN HILL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-7020
Practice Address - Country:US
Practice Address - Phone:435-797-0576
Practice Address - Fax:844-308-5865
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN175462084P0800X
FLME1217222084P0804X
GA781802084P0804X
UT11251499-12052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry