Provider Demographics
NPI:1760602700
Name:CONNIE D. HILL, PH.D.
Entity Type:Organization
Organization Name:CONNIE D. HILL, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-428-7395
Mailing Address - Street 1:125 CHURCH ST NE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8638
Mailing Address - Country:US
Mailing Address - Phone:770-428-7395
Mailing Address - Fax:770-428-1964
Practice Address - Street 1:125 CHURCH ST NE
Practice Address - Street 2:SUITE 210
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8638
Practice Address - Country:US
Practice Address - Phone:770-428-7395
Practice Address - Fax:770-428-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR74734Medicare UPIN
GA68BBCKDMedicare ID - Type Unspecified