MEDICARE: GARLINGTON HALLER VENTURES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1043170038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARLINGTON HALLER VENTURES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 8700
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39506-8700
Country	:	US
Telephone Number	:	615-547-5993
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 W HIGH ST
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2234
Country	:	US
Telephone Number	:	615-547-5993
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TIMOTHY H HALLER
Credential	:
Telephone Number	:	228-273-4002

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	11/13/2025

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