Provider Demographics
NPI:1558904169
Name:HALL, ANTHONY JAMES (APRN)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JAMES
Last Name:HALL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HIGHWAY 85 N # 310302
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7738
Mailing Address - Country:US
Mailing Address - Phone:678-551-7083
Mailing Address - Fax:678-487-5367
Practice Address - Street 1:1415 HIGHWAY 85 N # 310302
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7738
Practice Address - Country:US
Practice Address - Phone:678-551-7083
Practice Address - Fax:678-487-5367
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN200530363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health