Provider Demographics
NPI:1558723734
Name:HILL, AMADA
Entity Type:Individual
Prefix:
First Name:AMADA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 MACKENZIE DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-1802
Mailing Address - Country:US
Mailing Address - Phone:404-432-4014
Mailing Address - Fax:
Practice Address - Street 1:403 PERMIAN WAY
Practice Address - Street 2:SUITE A
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3252
Practice Address - Country:US
Practice Address - Phone:770-771-5235
Practice Address - Fax:770-771-5236
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily