Provider Demographics
NPI:1376104802
Name:HALL, JACQUELINE ALFORD (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ALFORD
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:SARAH
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5610
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010
Mailing Address - Country:US
Mailing Address - Phone:229-273-8881
Mailing Address - Fax:229-273-8985
Practice Address - Street 1:822 S HILL ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4842
Practice Address - Country:US
Practice Address - Phone:229-273-8881
Practice Address - Fax:229-273-8985
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233311163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse