Provider Demographics
NPI:1174057566
Name:HILL, MAISHA
Entity type:Individual
Prefix:
First Name:MAISHA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N DAVIDSON ST
Mailing Address - Street 2:307
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2928
Mailing Address - Country:US
Mailing Address - Phone:704-507-2904
Mailing Address - Fax:
Practice Address - Street 1:321 N DAVIDSON ST
Practice Address - Street 2:307
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2928
Practice Address - Country:US
Practice Address - Phone:704-507-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15676171W00000X
SC10258171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor