Provider Demographics
NPI:1558327809
Name:HILSEN, MITCHELL P (DPM)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:P
Last Name:HILSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 UPPER HEMBREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0929
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:1350 UPPER HEMBREE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0927
Practice Address - Country:US
Practice Address - Phone:770-663-8011
Practice Address - Fax:770-743-9820
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000858213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GABH6217221OtherDEA REGISTRATION
GABH6217221OtherDEA REGISTRATION
GA48SCCQHMedicare PIN
GAP00165056Medicare PIN
GAU76490Medicare UPIN