Provider Demographics
NPI:1386638880
Name:HALL, ALICIA ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 GREEN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2143
Mailing Address - Country:US
Mailing Address - Phone:812-265-9900
Mailing Address - Fax:812-265-9998
Practice Address - Street 1:2004 HAYES ST STE 260
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2646
Practice Address - Country:US
Practice Address - Phone:615-329-7969
Practice Address - Fax:615-284-7912
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39429207Q00000X
TN34216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64095888Medicaid
KY0622334Medicare ID - Type Unspecified
KY64095888Medicaid