Hillandale Internal Medicine, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

041109 Issued in GA

Legal business name

HILLANDALE INTERNAL MEDICINE, PC

Practice address

5900 Hillandale Dr
Annex E
Lithonia, GA 30058-3802

Phone

(770) 987-8400

Fax

(770) 987-8494

NPI assigned

Apr 5, 2011

Organization subpart

No

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

Authorized official

Name

Wallace Duncan, M.D.NPI 1821153529

Title

Ceo

Phone

(770) 987-8400

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Wallace Duncan, M.D.

  • Internal Medicine Physician
  • Lithonia, GA
  • NPI 1821153529
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301961600000",
    "number": "1861781320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 HILLANDALE DR",
            "address_2": "ANNEX E",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300583802",
            "telephone_number": "770-987-8400",
            "fax_number": "770-987-8494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 HILLANDALE DR",
            "address_2": "ANNEX E",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300583802",
            "telephone_number": "770-987-8400",
            "fax_number": "770-987-8494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLANDALE INTERNAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2011-04-05",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-987-8400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "041109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00687893G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Renae Heyward
• Krystie Heyward, RCS
• Rodney Hickman Jr.
• Sharon Denise Hicks, RN
• Angela Hill
• Hillandale Medical Associates, PC
• Hillandale Primary Care
• Hillandale Surgical Group
• Latasha Hillman
• Kya Hines, RBT

• 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 Apr 5, 2011; 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.