Provider Demographics
NPI:1487681847
Name:HILLIARD, LOUIS CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:CHARLES
Last Name:HILLIARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 VETERANS MEMORIAL HWY SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3144
Mailing Address - Country:US
Mailing Address - Phone:770-948-4511
Mailing Address - Fax:
Practice Address - Street 1:1196 VETERANS MEMORIAL HWY SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3144
Practice Address - Country:US
Practice Address - Phone:770-948-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V05573Medicare UPIN
GA35ZCJMFMedicare ID - Type Unspecified