Provider Demographics
NPI:1841227998
Name:HALL, CAROL ANN (DO)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2648
Mailing Address - Country:US
Mailing Address - Phone:402-709-4182
Mailing Address - Fax:
Practice Address - Street 1:10319 DIBERVILLE BLVD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2506
Practice Address - Country:US
Practice Address - Phone:229-396-2999
Practice Address - Fax:228-396-2113
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002331A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine