Provider Demographics
NPI:1134285281
Name:JAUDON-HALL, ANGELA (SERVICE COORDINATOR)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:JAUDON-HALL
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:JAUDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 TORTOISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:478-955-1410
Mailing Address - Fax:478-745-9040
Practice Address - Street 1:113 TORTOISE DRIVE
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-955-1410
Practice Address - Fax:478-745-9040
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000888104BMedicaid