Provider Demographics
NPI:1730310491
Name:HUGH W. HALL, M.D., L.L.C.
Entity Type:Organization
Organization Name:HUGH W. HALL, M.D., L.L.C.
Other - Org Name:COVENANT LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:W
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-364-6490
Mailing Address - Street 1:515 MCKINNES PARK
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4085
Mailing Address - Country:US
Mailing Address - Phone:706-364-6490
Mailing Address - Fax:706-364-0340
Practice Address - Street 1:515 MCKINNES PARK
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4085
Practice Address - Country:US
Practice Address - Phone:706-364-6490
Practice Address - Fax:706-364-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00664969CMedicaid
GA5111110609Medicare NSC
GAG07110Medicare UPIN