Provider Demographics
NPI:1730320870
Name:HALL, BARBARA S (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:1079 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8725
Practice Address - Country:US
Practice Address - Phone:803-749-8900
Practice Address - Fax:803-749-8899
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3824363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1496Medicaid
SCNP1496Medicaid
SCSC26305773Medicare PIN
SCSC2630A871Medicare PIN