Basic Information
Provider Information
NPI: 1295097236
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: GINGER
MiddleName: LIANE
NamePrefix: MRS.
NameSuffix:  
Credential: BCBA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1215 HIGHTOWER TRAIL
Address2: BLDG. B #120
City: ATLANTA
State: GA
PostalCode: 30350
CountryCode: US
TelephoneNumber: 8667505554
FaxNumber: 6782811609
Practice Location
Address1: 1215 HIGHTOWER TRAIL
Address2: BLDG. B #120
City: ATLANTA
State: GA
PostalCode: 30350
CountryCode: US
TelephoneNumber: 8667505554
FaxNumber: 6782811609
Other Information
ProviderEnumerationDate: 06/14/2012
LastUpdateDate: 02/01/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X1-11-8354CAY Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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