Provider Demographics
NPI:1104394857
Name:HALL, GEORGE SCOTT SR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:SCOTT
Last Name:HALL
Suffix:SR
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 1:9 MARSH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-6413
Mailing Address - Country:US
Mailing Address - Phone:904-277-8031
Mailing Address - Fax:
Practice Address - Street 1:9 MARSH CREEK RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-6413
Practice Address - Country:US
Practice Address - Phone:904-277-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY187972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty