Hillandale Medical Associates, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

34265 Issued in GA

Legal business name

HILLANDALE MEDICAL ASSOCIATES, PC

Practice address

5910 Hillandale Dr
Suite 202
Lithonia, GA 30058-1884

Phone

(770) 808-0092

Fax

(770) 808-0380

NPI assigned

Jun 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sherell D Vicks, MDNPI 1932251253

Title

Owner

Phone

(770) 808-0092

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sherell Denise Vicks, M.D.

  • Internal Medicine Physician
  • Lithonia, GA
  • NPI 1932251253
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598962706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5910 HILLANDALE DR",
            "address_2": "SUITE 202",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300581884",
            "telephone_number": "770-808-0092",
            "fax_number": "770-808-0380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5910 HILLANDALE DR",
            "address_2": "SUITE 202",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300581884",
            "telephone_number": "770-808-0092",
            "fax_number": "770-808-0380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLANDALE MEDICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VICKS",
        "authorized_official_first_name": "SHERELL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-808-0092",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "34265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00641935C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11BDTLM",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krystie Heyward, RCS
• Rodney Hickman Jr.
• Sharon Denise Hicks, RN
• Angela Hill
• Hillandale Internal Medicine, PC
• Hillandale Primary Care
• Hillandale Surgical Group
• Latasha Hillman
• Kya Hines, RBT
• His Grace Home Care LLC

• Internal Medicine Physician in Lithonia, GA
• Providers in Lithonia, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.