Provider Demographics
NPI:1770609364
Name:HILL CHANCE, GERRI L (MD)
Entity type:Individual
Prefix:
First Name:GERRI
Middle Name:L
Last Name:HILL CHANCE
Suffix:
Gender:F
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:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083
Mailing Address - Country:US
Mailing Address - Phone:601-894-5110
Mailing Address - Fax:601-894-5154
Practice Address - Street 1:206 ROBERT MCDANIEL DRIVE
Practice Address - Street 2:
Practice Address - City:HAZELHURST
Practice Address - State:MS
Practice Address - Zip Code:39083
Practice Address - Country:US
Practice Address - Phone:601-894-5110
Practice Address - Fax:601-894-5154
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS142082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121554Medicaid
MS00121554Medicaid