Provider Demographics
NPI:1538142179
Name:HALL, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4620
Mailing Address - Country:US
Mailing Address - Phone:864-233-5722
Mailing Address - Fax:864-233-6027
Practice Address - Street 1:1126 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4620
Practice Address - Country:US
Practice Address - Phone:864-233-5722
Practice Address - Fax:864-233-6027
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21728207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0876Medicaid
SCG26046Medicare UPIN