Provider Demographics
NPI:1164442794
Name:HALL, JOHN EDWARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:HALL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 MARTIN LUTHER KING JR DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-2943
Mailing Address - Country:US
Mailing Address - Phone:404-753-9742
Mailing Address - Fax:404-753-9743
Practice Address - Street 1:1099 MARTIN LUTHER KING JR DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2943
Practice Address - Country:US
Practice Address - Phone:404-753-9742
Practice Address - Fax:404-753-9743
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist