Provider Demographics
NPI:1376968578
Name:HALL, WILLIAM RUSSELL (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:HALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1199 PRINCE AVE
Mailing Address - Street 2:ATHENS REGIONAL MEDICAL CENTER
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2797
Mailing Address - Country:US
Mailing Address - Phone:706-475-5865
Mailing Address - Fax:706-475-6771
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:ATHENS REGIONAL MEDICAL CENTER
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-5865
Practice Address - Fax:706-475-6771
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT 004813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist