Provider Demographics
NPI:1417298878
Name:HALL, ANTHONY
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:205 CECIL ST
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-4666
Mailing Address - Country:US
Mailing Address - Phone:229-894-6659
Mailing Address - Fax:229-776-6368
Practice Address - Street 1:205 CECIL ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-4666
Practice Address - Country:US
Practice Address - Phone:229-894-6659
Practice Address - Fax:229-776-6368
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107102035343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)