Provider Demographics
NPI:1942592803
Name:HALL, SAMANTHA A (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:629-208-6008
Practice Address - Street 1:3901 CENTRAL PIKE STE 353
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3422
Practice Address - Country:US
Practice Address - Phone:615-220-8788
Practice Address - Fax:615-220-8688
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2411213ES0103X
OH36.003735213ES0103X
TN782213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery