Provider Demographics
NPI:1720647464
Name:HALL, KIMBERLY J (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 12TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2938
Mailing Address - Country:US
Mailing Address - Phone:706-324-0471
Mailing Address - Fax:706-324-0473
Practice Address - Street 1:1604 12TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2938
Practice Address - Country:US
Practice Address - Phone:706-324-0471
Practice Address - Fax:706-324-0473
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology