Provider Demographics
NPI:1437121639
Name:HALL, PAMELA G (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:G
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 1:2002 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-2054
Mailing Address - Country:US
Mailing Address - Phone:706-438-1122
Mailing Address - Fax:706-438-4254
Practice Address - Street 1:2002 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2054
Practice Address - Country:US
Practice Address - Phone:706-342-1555
Practice Address - Fax:706-342-3917
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00951233AMedicaid
GAH60246Medicare UPIN
GA00951233AMedicaid