Provider Demographics
NPI:1942361688
Name:HILLESHEIM, PAUL B (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:HILLESHEIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WEST 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165
Mailing Address - Country:US
Mailing Address - Phone:706-291-8702
Mailing Address - Fax:706-291-6514
Practice Address - Street 1:311 WEST 8TH STREET
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:706-291-8702
Practice Address - Fax:706-291-6514
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004008A207ZD0900X
GA80728207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG04766AMedicaid