Provider Demographics
NPI:1841206240
Name:HERD, HAL M (MD)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:M
Last Name:HERD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:595 HURRICANE SHOALS ROAD NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-995-0823
Mailing Address - Fax:770-995-7018
Practice Address - Street 1:595 HURRICANE SHOALS ROAD NW
Practice Address - Street 2:SUITE 300
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-995-0823
Practice Address - Fax:770-995-7018
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-10-19
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Provider Licenses
StateLicense IDTaxonomies
GA013140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00009589CMedicaid
GA00009589AMedicaid
GA00009589BMedicaid