Healthcare Provider Details

I. General information

NPI: 1912103623
Provider Name (Legal Business Name): GINNENE A.G. HALL RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11975 MORRIS RD SUITE 200
ALPHARETTA GA
30005-4419
US

IV. Provider business mailing address

6285 BARFIELD RD NE SUITE 250
ATLANTA GA
30328-4303
US

V. Phone/Fax

Practice location:
  • Phone: 770-751-3600
  • Fax: 770-751-3615
Mailing address:
  • Phone: 404-303-1224
  • Fax: 404-303-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN145224
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: