Provider Demographics
NPI:1164953675
Name:HILLMON-SCRUGGS, EBONY (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:HILLMON-SCRUGGS
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W GORDON ST STE A202
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-4569
Mailing Address - Country:US
Mailing Address - Phone:229-474-4101
Mailing Address - Fax:229-349-6006
Practice Address - Street 1:202 W GORDON ST STE A202
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4569
Practice Address - Country:US
Practice Address - Phone:229-474-4101
Practice Address - Fax:229-349-6006
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269512363LF0000X
GARN169512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily