Provider Demographics
NPI:1518670561
Name:HALL, MITCHELL HEATH
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:HEATH
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3722
Mailing Address - Country:US
Mailing Address - Phone:304-939-0567
Mailing Address - Fax:
Practice Address - Street 1:132 LOCUST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-3722
Practice Address - Country:US
Practice Address - Phone:304-939-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant