Provider Demographics
NPI:1952825838
Name:HILL, MARY L (HAIR LOSS SPECIALIS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:HILL
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 THORNTON DR.
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:770-329-0427
Mailing Address - Fax:
Practice Address - Street 1:185 THORNTON DR.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-329-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
GACOI001814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management