Provider Demographics
NPI:1447570858
Name:HALL, JONATHAN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:HALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 CENTRAL AVENUE
Mailing Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-260-8551
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:2953 BROAD AVE
Practice Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-2957
Practice Address - Country:US
Practice Address - Phone:901-271-6050
Practice Address - Fax:901-271-6099
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520339Medicaid