Provider Demographics
NPI:1578080222
Name:HALL, DEBRA LEE (FNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 GA HIGHWAY 257
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-1137
Mailing Address - Country:US
Mailing Address - Phone:478-290-1861
Mailing Address - Fax:
Practice Address - Street 1:195 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:GA
Practice Address - Zip Code:30411-4055
Practice Address - Country:US
Practice Address - Phone:912-568-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily