MEDICARE: DR. INGRID A HALL DPH.

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	183500000X	Pharmacist	3496	TN

General Provider Information

NPI Number	:	1477633691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INGRID A HALL DPH.

Provider Business Mailing Address
First Line	:	770 EDGEWATER AVE
Second Line	:
City	:	DAYTON
State	:	TN
Zip	:	37321-4230
Country	:	US
Telephone Number	:	423-775-2672
Fax Number	:	423-775-2672

Provider Business Practice Location Address
First Line	:	420 MARKET ST
Second Line	:	SUITE 3
City	:	DAYTON
State	:	TN
Zip	:	37321-1638
Country	:	US
Telephone Number	:	423-570-0325
Fax Number	:	423-570-0325

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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