Provider Demographics
NPI:1073501276
Name:HALL, VIRGINIA CHILDS (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CHILDS
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:520 CHARTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4871
Mailing Address - Country:US
Mailing Address - Phone:478-477-6700
Mailing Address - Fax:478-757-8135
Practice Address - Street 1:520 CHARTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4871
Practice Address - Country:US
Practice Address - Phone:478-477-6700
Practice Address - Fax:478-757-8135
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA062509207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2156040OtherUNITED HEALTHCARE