Provider Demographics
NPI:1568438521
Name:HALL, ERIC LEE (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
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 1:512 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4344
Mailing Address - Country:US
Mailing Address - Phone:912-369-5437
Mailing Address - Fax:912-369-5740
Practice Address - Street 1:512 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4344
Practice Address - Country:US
Practice Address - Phone:912-369-5437
Practice Address - Fax:912-369-5740
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00807496AMedicaid
GA37BBFHNMedicare ID - Type Unspecified
GAG87515Medicare UPIN