Provider Demographics
NPI:1811007313
Name:HALL, JAMES EMORY (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EMORY
Last Name:HALL
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 D A BIGLANE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601
Mailing Address - Country:US
Mailing Address - Phone:601-833-6363
Mailing Address - Fax:601-833-6364
Practice Address - Street 1:1022 D A BIGLANE DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601
Practice Address - Country:US
Practice Address - Phone:601-833-6363
Practice Address - Fax:601-833-6364
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD7311207W00000X
AL00008686207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5816550001OtherP-TAN
MS00011658Medicaid
MS00011658Medicaid