MEDICARE: TIMOTHY HALL

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	207P00000X	Emergency Medicine Physician	12241	SC
2	207P00000X	Emergency Medicine Physician	28203	NC

General Provider Information

NPI Number	:	1144200429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY HALL

Provider Business Mailing Address
First Line	:	101 E W T HARRIS BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3485
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E W T HARRIS BLVD
Second Line	:	SUITE 5203
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3485
Country	:	US
Telephone Number	:	704-863-9300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	02/12/2019

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Directions to “ TIMOTHY HALL ” Practice Location

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