Provider Demographics
NPI:1982989091
Name:HALLS FAMILY WALK-IN CLINIC, LLC
Entity Type:Organization
Organization Name:HALLS FAMILY WALK-IN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:ATCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:APN, BC - FNP
Authorized Official - Phone:731-836-9444
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-0092
Mailing Address - Country:US
Mailing Address - Phone:731-836-9444
Mailing Address - Fax:731-836-9443
Practice Address - Street 1:115 W TIGRETT ST
Practice Address - Street 2:APT A
Practice Address - City:HALLS
Practice Address - State:TN
Practice Address - Zip Code:38040-1256
Practice Address - Country:US
Practice Address - Phone:731-836-9444
Practice Address - Fax:731-836-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
103G709896Medicare PIN