Provider Demographics
NPI:1720623879
Name:HILL, CLEMMIE TOM
Entity Type:Individual
Prefix:MR
First Name:CLEMMIE
Middle Name:TOM
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 JOE LOUIS DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-1217
Mailing Address - Country:US
Mailing Address - Phone:678-333-9375
Mailing Address - Fax:
Practice Address - Street 1:187 JOE LOUIS DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-1217
Practice Address - Country:US
Practice Address - Phone:678-333-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health