Provider Demographics
NPI:1831209147
Name:HALL, R ALAN (MD)
Entity type:Individual
Prefix:
First Name:R
Middle Name:ALAN
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30053
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-0053
Mailing Address - Country:US
Mailing Address - Phone:912-355-8188
Mailing Address - Fax:
Practice Address - Street 1:815 E 63RD ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4420
Practice Address - Country:US
Practice Address - Phone:912-355-8188
Practice Address - Fax:912-356-6970
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031994208G00000X
GA64818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
780001652OtherRAILROAD MEDICARE
WAMD5703WOtherALASKA MEDICAID
WA8169419Medicaid
WA0030021OtherLABOR & INDUSTRY
WAUS0862357OtherAETNA/USHC SPECIALIST
WAHA0297OtherBLUE SHIELD
WA8169419Medicaid
WAMD5703WOtherALASKA MEDICAID
WA000182405Medicare PIN