Provider Demographics
NPI:1083678411
Name:HALL, JOHN WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAYNE
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:67 CREEKSIDE PARK CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4810
Practice Address - Country:US
Practice Address - Phone:864-242-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL266626207L00000X
AL26626207LP2900X
SC37034207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556471Medicaid
AL1083678411OtherTRICARE
AL51002019OtherBLUE CROSS BLUE SHIELD AL
GA554738662AMedicaid
ALP00241498OtherRAILROAD MEDICARE
GA554738662AMedicaid
AL51002019OtherBLUE CROSS BLUE SHIELD AL