Provider Demographics
NPI:1962669572
Name:ERIC L. HALL, MD; PC
Entity Type:Organization
Organization Name:ERIC L. HALL, MD; PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-369-5437
Mailing Address - Street 1:512 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4325
Mailing Address - Country:US
Mailing Address - Phone:912-369-5437
Mailing Address - Fax:912-369-5740
Practice Address - Street 1:512 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4325
Practice Address - Country:US
Practice Address - Phone:912-369-5437
Practice Address - Fax:912-369-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0458142080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA585349667AMedicaid
GA585349667AMedicaid