Provider Demographics
NPI:1114280591
Name:HALL, RASHEEDA CROWELL (MD)
Entity Type:Individual
Prefix:
First Name:RASHEEDA
Middle Name:CROWELL
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:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-450-0794
Practice Address - Street 1:100 HIGHWAY 535
Practice Address - Street 2:
Practice Address - City:SEMINARY
Practice Address - State:MS
Practice Address - Zip Code:39479
Practice Address - Country:US
Practice Address - Phone:601-722-3208
Practice Address - Fax:601-722-3304
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00028059Medicaid
MS598485YJ69OtherMS MEDICARE
MS14200819OtherCAQH - MS