Provider Demographics
NPI:1679045736
Name:HILL, JANDA' (FNP)
Entity Type:Individual
Prefix:
First Name:JANDA'
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5043 CEYLON CT
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2632
Mailing Address - Country:US
Mailing Address - Phone:810-597-7945
Mailing Address - Fax:
Practice Address - Street 1:1810 MULKEY ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2632
Practice Address - Country:US
Practice Address - Phone:770-732-8464
Practice Address - Fax:770-732-8462
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN237437207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty