Provider Demographics
NPI:1689902967
Name:HICKORY HILL EMERGENCY PHYSICIANS
Entity Type:Organization
Organization Name:HICKORY HILL EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-444-7009
Mailing Address - Street 1:815 S PALAFOX ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5960
Mailing Address - Country:US
Mailing Address - Phone:800-444-7009
Mailing Address - Fax:800-305-3233
Practice Address - Street 1:521 W. HILL STREET
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-2199
Practice Address - Country:US
Practice Address - Phone:706-595-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA977483105AMedicaid
GA977483105AMedicaid