Provider Demographics
NPI:1598099509
Name:HALL, LADAWN JERVANICKIO
Entity Type:Individual
Prefix:
First Name:LADAWN
Middle Name:JERVANICKIO
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 PACE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-6652
Mailing Address - Country:US
Mailing Address - Phone:678-999-6416
Mailing Address - Fax:
Practice Address - Street 1:2131 PACE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-6652
Practice Address - Country:US
Practice Address - Phone:678-999-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No374700000XNursing Service Related ProvidersTechnician