Provider Demographics
NPI:1487258083
Name:HILLIARD, KERRI BLAIR
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:BLAIR
Last Name:HILLIARD
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 1:6175 LAKE OAK LNDG
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9575
Mailing Address - Country:US
Mailing Address - Phone:678-207-9939
Mailing Address - Fax:
Practice Address - Street 1:6327 HIGHWAY 53 E
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6250
Practice Address - Country:US
Practice Address - Phone:706-216-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist