Provider Demographics
NPI:1003078296
Name:HALL, CARZADEAN BERNADETTE (MD)
Entity Type:Individual
Prefix:
First Name:CARZADEAN
Middle Name:BERNADETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 FRANKLIN FARMS CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3361
Mailing Address - Country:US
Mailing Address - Phone:404-216-0132
Mailing Address - Fax:
Practice Address - Street 1:185 FRANKLIN FARMS CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3361
Practice Address - Country:US
Practice Address - Phone:404-216-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034309207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine