Provider Demographics
NPI:1649853714
Name:HALL, CAMERON BOYLE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CAMERON
Middle Name:BOYLE
Last Name:HALL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MUSGROVE ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-6428
Mailing Address - Country:US
Mailing Address - Phone:912-816-7150
Mailing Address - Fax:
Practice Address - Street 1:100 MUSGROVE ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6428
Practice Address - Country:US
Practice Address - Phone:912-816-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered