Provider Demographics
NPI:1932404662
Name:HALL, PATRICIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W GORDON ST STE C
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3480
Mailing Address - Country:US
Mailing Address - Phone:706-647-7009
Mailing Address - Fax:706-647-7014
Practice Address - Street 1:612 W GORDON ST STE C
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3480
Practice Address - Country:US
Practice Address - Phone:706-647-7009
Practice Address - Fax:706-647-7014
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine