Healthcare Provider Details

I. General information

NPI: 1518792811
Provider Name (Legal Business Name): DAPHANY HALL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

7320 BIRCH CREEK TRL
PIKE ROAD AL
36064-0020
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: