Provider Demographics
NPI:1962676601
Name:JOHN E HALL, JR., D.D.S., P.C.
Entity Type:Organization
Organization Name:JOHN E HALL, JR., D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:W
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-753-9742
Mailing Address - Street 1:1099 M L K JR DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-2943
Mailing Address - Country:US
Mailing Address - Phone:404-753-9742
Mailing Address - Fax:404-753-9743
Practice Address - Street 1:1099 M L K JR DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2943
Practice Address - Country:US
Practice Address - Phone:404-753-9742
Practice Address - Fax:404-753-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1164442794OtherINDIVIDUAL NPI
GA00271411AMedicaid