Provider Demographics
NPI:1144575184
Name:HALL, KATHERINE R (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:R
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 COOK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3486
Mailing Address - Country:US
Mailing Address - Phone:423-744-7585
Mailing Address - Fax:423-744-7075
Practice Address - Street 1:711 COOK DR
Practice Address - Street 2:STE 100
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3486
Practice Address - Country:US
Practice Address - Phone:423-744-7585
Practice Address - Fax:423-744-7075
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50798207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine