Provider Demographics
NPI:1316581135
Name:HALL, MADISON L (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 CEDAR PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8701
Mailing Address - Country:US
Mailing Address - Phone:704-438-9383
Mailing Address - Fax:704-438-9383
Practice Address - Street 1:10021 CEDAR PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8701
Practice Address - Country:US
Practice Address - Phone:704-438-9383
Practice Address - Fax:704-438-9383
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013499363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1316581135Medicaid