Provider Demographics
NPI:1902212467
Name:HALL, NINA GERMAN (PHD, RD, LD/N)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:GERMAN
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 INTERLAKE PASS
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8056
Mailing Address - Country:US
Mailing Address - Phone:770-914-7056
Mailing Address - Fax:
Practice Address - Street 1:369 INTERLAKE PASS
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-8056
Practice Address - Country:US
Practice Address - Phone:678-763-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered