Provider Demographics
NPI:1700189073
Name:HALL, PEGGY L (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 14TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1329
Mailing Address - Country:US
Mailing Address - Phone:229-888-4097
Mailing Address - Fax:229-888-4098
Practice Address - Street 1:806 14TH AVE STE C
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1329
Practice Address - Country:US
Practice Address - Phone:229-888-4097
Practice Address - Fax:229-888-4098
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162539 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily