Provider Demographics
NPI:1467821025
Name:HALE, JEFFREY (RD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HALE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 OAKCREST DR APT 822
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1731
Mailing Address - Country:US
Mailing Address - Phone:763-221-9356
Mailing Address - Fax:
Practice Address - Street 1:2005 N BELTLINE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3972
Practice Address - Country:US
Practice Address - Phone:803-782-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered