Provider Demographics
NPI:1245894427
Name:HALL, AUSTIN TODEY (PAC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:TODEY
Last Name:HALL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:BROOKE
Other - Last Name:TODEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1439 CHESHIRE WAY NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3159
Mailing Address - Country:US
Mailing Address - Phone:770-289-2320
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD MILTON PKWY STE C290
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-6491
Practice Address - Country:US
Practice Address - Phone:770-667-4343
Practice Address - Fax:770-772-0937
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA00000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program