Provider Demographics
NPI:1922617950
Name:HILL, FRED E (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:E
Last Name:HILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 JERVEY POINT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8372
Mailing Address - Country:US
Mailing Address - Phone:148-043-3405
Mailing Address - Fax:
Practice Address - Street 1:1033 JERVEY POINT RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8372
Practice Address - Country:US
Practice Address - Phone:148-043-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37654207Q00000X
FLME85403207Q00000X
LAMD.207574207Q00000X
OH35-044916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine