Provider Demographics
NPI:1003036252
Name:HALL-HILL, TESIA SHANI (DO)
Entity Type:Individual
Prefix:DR
First Name:TESIA
Middle Name:SHANI
Last Name:HALL-HILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 W NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-4454
Mailing Address - Country:US
Mailing Address - Phone:601-362-5321
Mailing Address - Fax:601-364-5159
Practice Address - Street 1:5429 ROBINSON ROAD EXT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204
Practice Address - Country:US
Practice Address - Phone:601-914-0163
Practice Address - Fax:601-914-0170
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00937242Medicaid
MS251936Medicare Oscar/Certification
MS080004177Medicare PIN
MSI37668Medicare UPIN
MS251850Medicare Oscar/Certification
MS251933Medicare Oscar/Certification
MSC01051Medicare Oscar/Certification