Provider Demographics
NPI:1457309544
Name:HILL, CHARLES E (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:HILL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:ROOM F147A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-712-4615
Mailing Address - Fax:404-712-5567
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:ROOM F147A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-712-4615
Practice Address - Fax:404-712-5567
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047766207ZP0007X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI13114Medicare UPIN