Provider Demographics
NPI:1184355661
Name:HILL, SUMMER LARAE (PA)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:LARAE
Last Name:HILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MILTON AVE SE APT 2106
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-2331
Mailing Address - Country:US
Mailing Address - Phone:769-798-6324
Mailing Address - Fax:
Practice Address - Street 1:1300 ERNEST W BARRETT PKWY NW STE 260
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-5005
Practice Address - Country:US
Practice Address - Phone:769-798-6324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant