Provider Demographics
NPI:1447391867
Name:KILLIAN HILL ORTHOPAEDIC & SPORTS MEDICINE CLINIC, PC
Entity Type:Organization
Organization Name:KILLIAN HILL ORTHOPAEDIC & SPORTS MEDICINE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CONAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-923-2700
Mailing Address - Street 1:966 KILLIAN HILL RD SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3102
Mailing Address - Country:US
Mailing Address - Phone:770-923-2700
Mailing Address - Fax:770-923-3553
Practice Address - Street 1:966 KILLIAN HILL RD SW
Practice Address - Street 2:SUITE B
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3102
Practice Address - Country:US
Practice Address - Phone:770-923-2700
Practice Address - Fax:770-923-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014147207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE54849Medicare UPIN